LIBRARY OF CONGRESS. 



djfap. dopgrigjjjt In 

Shelf : 3 



UNITED STATES OF AMERICA. 



INSOMNIA; 



AND OTHER 



Disorders op Sleep. 



HENRY Iff. LYMAN, A.M., M.D., 

Professor of Physiology, and of Diseases of the Nervous System, In Rush Medical 

College ; Professor of Theory and Practice of Medicine, In the 

Woman's Medical College ; and Physician to the 

Presbyterian Hospital, Chicago, 111. 







CHICAGO: 
W. T. KEENER, 

96 WASHINGTON STREET. 

1885. 



* 






COPYRIGHT, 1885. 



B. B. DONNELLEY <fc SOXS. PRIXTEBS, CHICAGO. 



PREFACE 



Tired Nature's sweet restorer, balmy sleep. 

— Yottng. 

The regularly recurring incidence of natural sleep 
forms one of the most important subjects for physio- 
logical investigation. Were it an event of rare occur- 
rence, it would excite a degree of astonishment and 
alarm equal to the agitation now experienced by the 
spectator of an ordinary attack of syncope or of 
epileptic convulsion. But, so completely does the 
recurrence of sleep harmonize with all the other facts 
of life that Ave are as indifferent to its nature as we 
are to every other healthy function of the body. It is 
only when the mind has undertaken a critical observa- 
tion of the bodily and mental changes which accom- 
pany and condition the phenomenon that we begin to 
comprehend its wonderful character. Ushered in by 
a waning activity of body and mind that no effort of 
the will can long resist, nothing could more forcibly 
suggest the idea of approaching dissolution if, from 
the very earliest period of unconscious infancy, 
we had not been accustomed to the dominion of this 
imperious necessity. The remarkable likeness between 
the fading of consciousness in sleep and its extinction 

(iii) 



IV PREFACE. 

in death has, in all ages and among all people, arrested 
the attention of poets and philosophers of every 
degree. 

Soft repose, 
A living semblance of the grave, 

sang old Thomas Miller; and, describing, in Milton's 
stately verse, the close of his first day in the garden of 
Eden, Adam says: 

Gentle sleep 
First found me, and with soft oppression seized 
My drowsy sense, untroubled, though I thought 
I then was passing to my former state 
Insensible, and forthwith to dissolve. 

How wonderful is death, 
Death and his brother, Sleep! 

exclaims Shelley, echoing the marvellous strains that 
have come down to us from the days of Homer and 
Hesiod. In that venerable literature Sleep and Death 
are represented as twin brothers, sons of Night ; dwell- 
ing in the lower world of spirits, whence they come 
forth to perform the will of the Olympian Gods. 

The prosaic genius of our scientific generation no 
longer tolerates such lively exercise of the imagina- 
tion. The splendid anthropomorphism of the Hebrew 
poet, looking out upon the silent night, and cheering 
his soul with the sonorous exclamation, 

Behold, he that keepeth Israel 
Shall neither slumber nor sleep 



For so he giveth his beloved sleep, 

has become a mere memory of childhood. Words- 



PREFACE. V 

worth understood the full significance of this change 
when he wrote: 

There was a time when meadow, grove, and stream, 
The earth, and every common sight, 
To me did seem 
Apparelled in celestial light, 
The glory and the freshness of a dream. 
It is not now as it has been of yore; 
Turn whereso'er I may, 
By night or day, 
The things which I have seen I now can see no more! 

. . . I know, where'er I go, 
That there has passed away a glory from the earth. 

If, however, despite the loss of much that was 
beautiful and attractive in the myths of antiquity, we 
take advantage of the 

Years that bring the philosophic mind, 

we shall surely find in the - scientific investigation of 
sleep enough to awaken " thoughts too deep for " 
words. 



CONTENTS. 



CHAPTER I. 

THE NATURE AND CAUSE OF SLEEP. 

Definition of sleep — The invasion of sleep — The hypnagogic state — 
Depth and duration of sleep — Diagrammatic illustration of the 
phases of sleep — Modifications of physiological functions pro- 
duced by sleep — Effect of sleep upon the processes of respira- 
tion, circulation, calorification, secretion, and nutrition — Conse- 
quences of the progressive invasion of the nervous system by 
sleep — Effect upon the organs of special sense — Effects observed 
in the muscular apparatus of the body — Conditjpn of intellectual 
functions during the invasion of sleep — Does the mind ever 
sleep? — Arguments adduced by Sir William Hamilton and 
others to prove the continued activity of the mind during the 
sleep of the brain — Reasons for supposing that the mind may 
sleep — Variability of the depth of sleep — Experiments of Kohl- 
schuter to estimate the degree of variation — Alternation of day 
and night considered as a cause of sleep — Diminution of sensa- 
tion a cause of sleep — Illustrative observation by Strumpell — 
Fatigue a cause of sleep — Hypothesis of Obersteiner regarding 
the cause of sleep — Hypothesis of Pfliiger — Production of arti- 
ficial sleep by impregnation of the brain with narcotic sub- 
stances — Analogous production of natural sleep by accumulation 
of cerebral waste-products — Observations regarding the duration 
of sensory impressions requisite for the excitement of conscious 
perception — Difference between syncope and sleep — Observa- 
tions of Mosso regarding the state of the cerebral circulation 
during sleep — Cause of the change in the cerebral circulation 
during sleep — Molecular conditions necessary for the production 
of sleep — Somnolence — Sleeping Dropsy, or Maladie du Som- 
meil — Coma — Lethargy — Apparent death — Lucid lethargy, 
(vil) 



vm CONTENTS. 

CHAPTER II. 

INSOMNIA, OR WAKEFULNESS. 

Causes of insomnia — Affections of the organs of special sense — 
Effects of light — Effect of sound — Impressions upon the organs 
of smell and taste — Disturbances caused by a high temperature — 
Atmospheric and electrical disturbances — Effects produced by 
cold — Hibernation of animals — Disturbances of sleep occasioned 
by painful sensations — Disorders of the sympathetic nerves — 
Morbid states of the central nervous organs — Disorders of 
circulation and nutrition — Hyperemia of the brain — Anaemia 
and starvation of the brain — Effects of tea and coffee — Effect of 
alcohol — Inflammations, degenerations, and tumors affecting 
the brain — Excitement of the brain by diseased conditions of 
of the blood. - - - - 33 

CHAPTER III. 

REMEDIES FOR INSOMNIA. 

Serious consequences of insomnia — Its relation to cerebral diseases — 
Treatment of insomnia by moderation and control of the cere- 
bral circulation *- Remedial agents — Nervous stimulants and 
nervous sedatives — Heat — Baths — Massage — Electricity — 
Counter-irritants — Food — Digitalis — Camphor — Musk — Vale- 
rian — Cannabis indica — Belladonna — Hyoscyamus — Stramo- 
nium — Phosphorus — Acids — Opium — Cold — Alcohol — Paral- 
dehyde — Ether — Chloroform — Chloral — Buty lch loral hydrate — 
Amyl nitrite — Opium and opiates — Bromides — Hops — 
Gelsemium — Conium. -- 56 

CHAPTER IV. 

TREATMENT OF INSOMNIA IN PARTICULAR DISEASES. 

Insomnia in acute affections of the brain — In insanity — In chronic 
alcoholism and delirium tremens — In diseases of the heart and 
blood-vessels — In angina pectoris — In diseases of the respira- 
tory organs — In asthma — In renal diseases — In diseases of the 
liver — In gastro-intestinal diseases — In febrile conditions — In 
rheumatism and gout — In lithaemia — In syphilis — In disorders 
of nutrition — During pregnancy and after parturition — In 
spasmodic diseases — In childhood — In old age. - - - 92 



CONTENTS. IX 

CHAPTER V. 

DREAMS. 

Physiology of perception and of dreaming— Definition of the act of 
dreaming — Revery — Production of illusions and hallucinations 
by drugs and by disease — Effects of hasheesh — Effects of acute 
disease — Association of ideas — Memory of past sensations — 
Dreams produced by excitement of the different organs of 
sense — Persistence of dream-impressions after waking — Experi- 
ence of M. Baillarger — Of Professor Jessen — Belief of savages 
in the reality of dreams — Sensory dreams — Intellectual dreams 
— Repetition of dreams — Incoherence of dreams — Cause of the 
superior vividness of certain dreams — Duration of dreams — 
Dreams excited by morbid states of the body — Prophetic 
dreams — Their causes — Clairvoyant dreams — Hallucinatory 
dreams — Sir Edmund Hornby's experience — Hallucinations — 
Case related by Dr. E. II. Clarke — Revelation through dreams 
— Revival of memory in dreams. - - - - - 116 



CHAPTER VI. 

SOMNAMBULISM. 

Causes of somnambulism — Physiology of somnambulism — Varieties 
of the disorder — Maury's classification — Classification of Ball and 
Chambard — Diagrammatic representation of their classification 
— Somnambulic lethargy — Illustrative cases — Somnambulic 
dreams — Night terrors — Somnolentia or sleep-drunkenness — 
Sleep-walking — Illustrative cases — Condition of the special 
senses in somnambulism — Relation of memory to the somnam- 
bulic paroxysm — Illustrative cases — Occasional recollection of 
incidents connected with the somnambulic dream— Resem- 
blances between the somnambulic state and the condition of 
post-epileptic mania — Somnambulic visions — J. P. Frank's 
case — Mesnet's case — Somnambulic life — Its likeness with the 
double-consciousness of certain forms of epilepsy — Illustrative 
cases — General theory of somnambulism. - - - - 166 



x CONTENTS. 

CHAPTER VII. 

ARTIFICIAL SOMNAMBULISM OR HYPNOTISM. 

Antiquity of the phenomena of hypnotism — Modern observations — 
Physical conditions favorable to the phenomena — Methods of 
inducing the hypnotic state — Duration of hypnotic sleep — Rudi- 
mentary states of hypnotism — Investigations of the Society for 
Psychical Research — Mind-reading — Physiological explanation 
of the process — Charcot's observations on artificial somnam- 
bulism — Cataleptic variety of the hypnotic state — Lethargic 
variety — Somnambulic variety — Hypnotic clairvoyance — 
Exalted sensibility of the brain in hypnotic states — Suscepti- 
bility to suggestions from without — Phenomena of so-called 
spiritualism — Table-rapping — Planchette — Therapeutical em- 
ployment of hypnotism — Metaphysical healing. - - - 212 



CHAPTER I. 

THE NATURE AND CAUSE OF SLEEP. 

Worn out, friend, is every theory, 
But green tne golden tree of life. 



— Goethe. 



Natural sleep is that condition of physiological 
repose in which the molecular movements of the 
brain are no longer fully and clearly projected upon 
the field of consciousness. This condition is univer- 
sally observed in all healthy animals: ami its recur- 
rence is intimately associated with the diurnal revolu- 
tion of the earth, and the succession of day and night. 
The disappearance of daylight is, for the majority of 
living creatures, the signal for cessation of active life. 
Though its onset may be for a time delayed by an 
effort of the will, the need of rest at length overcomes 
all opposition, and the most untoward circumstances 
cannot then prevent the access of unconsciousness. 
The story of the sailor-boy, sleeping on " the high and 
giddy mast," is familiar to every one. An officer in the 
United States Navy has assured me of more than one 
instance in which men had fallen asleep under his own 
eyes, oppressed by exhaustion, during the roar of a 
long continued bombardment. Thus produced, the 
relation of cause and effect between weariness and 
sleep becomes very apparent. The refreshing influ- 
ence of such repose points clearly to the restorative 

(i) 



z INSOMNIA. 

character of the physiological processes which persist 
during the suspension of consciousness. It also ren- 
ders evident the final cause of that periodical interrup- 
tion of activity which the brain experiences in com- 
mon with every other living structure. 

Sleep is usually preceded for some time by a feeling 
of sleepiness. This sensation, like the analogous sen- 
sations of hunger and thirst, represents in some meas- 
ure the progressive diminution of energy throughout 
the entire body ; but it is chiefly expressive of the fail- 
ure of cerebral energy. It produces a sense of gen- 
eral heaviness and intellectual dullness; the special 
senses become less alert, the eyelids droop, numerous 
groups of muscles experience the spasmodic contrac- 
tion of yawning, the head drops forward and is recov- 
ered with a jerk, the limbs relax, and the whole body 
tends to assume a position convenient for repose. 
Every school-boy who has been compelled to pass an 
evening hour at a dull lecture, under the eye of a 
martinet monitor, will testify to the suffering which 
attends any unusual prolongation of this period. But, 
if the natural course of events be not obstructed, the 
stage of mere sleepiness is soon passed, and the intro- 
ductory stage of sleep is entered. This is a state in 
which the individual is neither awake nor fully asleep. 
It is known as the hypnagogic state. During this 
period the phenomena of simple sleepiness become 
exaggerated to such a degree that the attitude of 
repose is assumed without effort if the body be per- 
mitted to follow the natural inclination of its different 
members. The eyes close, the other senses become 
inactive, though the sense of hearing is the most per- 



THE INVASION OF SLEEP. o 

sistent. Keleased in considerable measure from the 
control of the brain, the reflex energy of the spinal 
cord is at first somewhat exalted. Witness the fibril- 
lary twitching of the muscles, and the convulsive state, 
which may often be observed during the stage of som- 
nolence after severe fatigue. The uneasy sleeper may 
even be roused to complete wakefulness by such invol- 
untary movements. But, as sleep becomes more pro- 
found, the reflex functions of the cord are also weak- 
ened. 1 As the sensory organs retire from action, 
the intellectual faculties lose their equilibrium. First, 
the power of volition ceases. Then the logical asso- 
ciation of ideas comes to an end. The reasoning 
faculty disappears, and judgment is suspended. We 
become, therefore, no longer capable of surprise or 
astonishment at the vagaries of memory and of imag- 
ination, the only faculties that remain in action. To 
their more or less unfettered activity we owe the pre- 
sentation in consciousness of those disorderly pictures 
which, occurring in this stage of imperfect sleep, have 
been termed hypnagogic hallucinations. 2 During 
the early moments of this period an observant person 
may often retain a power of reasoning sufficient to 
remark the fact of dreaming, and this effort of atten- 
tion may produce a partial awakening; but, usually, 
the subsidence of cerebral function is progressive and 
rapid. The fire of imagination fades, the field of con- 
sciousness becomes less and less vividly illuminated, 
the entire nervous apparatus yields to the advancing 
tide, and, finally, the dominion of sleep is fully con- 

1 Rosenbach, Zeitschr. f. klin. med. 1881. Brain, Vol. IV, p. 138. 
9 Alfred Maury, Le Sommeil et les Reves, Chap. IV. 



INSOMNIA. 



firmed. The sleeper knows nothing of the external 
world, and has lost all consciousness of his own exist- 
ence. But the duration of profound repose is brief. 
From the end of the first hour the depth of sleep, at 
first, rapidly, then, more gradually, subsides. Dreams 
disturb its tranquility, mental activity increases, the 
power of volition revives, and, at the end of six or 
eight hours, the individual is once more awake. The 
subjoined diagram, borrowed from the Dictionaire 
Encyclopedique des Sciences M6dicales, will facilitate 
the apprehension of these successive phases in the 
course of sleep: 



o! 

o 

a 

o8 

bo 

t-, 

O 


05 

to 

3 
O 

o 

GO 

§ 


m 

<o 

45 
> 

a 
"Sb 

1 


§ 

05 

'■3 

a 

:o 

o 
O 


-3 

1 

o o 
05 ,r 
P.P" 


• 












Normal life. 




















First stage of sleep— Hypnagogic hal- 
lucinations. 


: 
















Second stage of sleep — Dreaming. 
























Third stage of sleep. 










- 










Profound sleep. 


1 








First stage of waking. 


laBBbfilS^^B 












Second stage of waking — Dreams. 










I 








Third stage of waking— Hypnagogic 
hallucinations. 


1 






1 








Complete awakening. 


1 









RESPIRATION DURING SLEEP. O 

It was formerly believed that during the time of 
sleep all the processes of assimilation and nutrition 
throughout the body are increased, — in short, that it 
is the season of repair for the waste of tissue incurred 
during the hours of wakeful activity. While it is true 
that in sleep the expenditure of force is greatly 
reduced, the more exact researches of modern physi- 
ologists indicate a universal reduction in the rate of 
all the vital processes. The final result, however, is a 
general renewal of energy, because the aggregate 
income of the tissues is greater than their outgo during 
the suspension of conscious activity. The following 
observations make very apparent the fact of a reduc- 
tion of physiological activity: 

Respiration. — The process of breathing is con- 
ducted with greater deliberation during the period of 
sleep. This reduction is one of the most notable of 
the circumstances that first attract the attention of 
the spectator who observes a sleeping person. The 
average number of respirations per minute, in an 
adult of twenty-five to thirty years of age, is sixteen. 
Quetelet remarked 1 that during sleep this number was 
diminished by about one-fourth. The same fact has 
been recorded by other observers. 2 Mosso has also 
noted the fact 8 that there is a change in the type of 
respiration, the movements during sleep become less 
diaphragmatic and more largely costal. He further- 
more observed that during the waking period the 
act of inspiration consumed 8-12 of the complete 

1 Hermann's Handbach der Physiologic, Vol. IV, Fart II, p. 98. 
9 Handbuch der Kinderkrankheiten, Vol. I, p. 346. 
3 llandbuch der Physiologic, Vol. IV, Pt. II, p 217. 



6 INSOMNIA. 

respiratory phase, but during sleep it was prolonged 
till it occupied 10-12 of the same cycle. The interval 
between the end of expiration and the commencement 
of inspiration was also obliterated by sleep. Notwith- 
standing this relative increase of inspiratory motion, 
the quantity of air that passes through the lungs is 
considerably reduced by reason of the diminished 
action of the diaphragm. A corresponding reduction 
of the gaseous exchanges between the blood and the 
external air has been determined by the experiments 
of Pettenkofer and Yoit, Boussingault, Lewin, and 
other equally competent observers. ' 

Circulation. — During sleep the heart beats less fre- 
quently than during the waking hours. Though a 
portion of this delay must be attributed to the recum- 
bent position, sleep does still further retard the move- 
ment of the heart. My own observations upon children 
in bed exhibit a difference of twelve to sixteen beats 
between the pulsations when awake and asleep. Ac- 
cording to Trousseau 2 the average number of pulsa- 
tions observed in a group of thirty children, varying in 
age from fifteen days to six months, was 140 when awake 
and 121 when asleep. In another group of twenty- 
nine children, between the ages of six months and 
twenty-one months, the average was 128 when awake 
and 112 when asleep. The observations of Hohl and • 
Allix 3 indicate that among very young children the 
difference between the pulse of sleep and the pulse 
of wakefulness may equal forty beats. According to 

1 Op. cit., pp, 142 and 456. 

2 Die. Encyc. des Sci. Med., Art. SOMMEIL, pp. 277. 

'Quoted by Vierordt, Handbuch der Kinderkrankheiten, Vol. I, p 307. 



TEMPERATURE DURING SLEEP. 7 

Guy ( loc. cit. ) the pulse is more variable in the morn- 
ing than during the afternoon or evening. 

Temperature. — Aside from the almost hourly fluc- 
tuations of the bodily temperature, a noticeable sink- 
ing of the temperature-curve is observed during the 
hours of sleep. This alone is sufficient to indicate a 
diminished rate of combustion in the tissues. Bous- 
singault found ' that a dove which consumed 255 mille- 
grammes of carbon every hour while awake, oxidized 
only 162 millegrammes when asleep. Scharling also 
observed that the quantities of carbon successively 
oxidized by the same man when asleep and awake bore 
to each other the ratio of 1 : 1.237. The observations of 
Demme 2 indicate that increase of bodily temperature 
during the hours of sleep must be considered as the 
result of pathological processes in the tissues. The 
observations of Allix ( loc. cit. ) , made upon sixteen chil- 
dren during the first twelve days after birth, showed 
an average fall of 0°.38 C. during the hours of sleep. 
Eight children, between five and sixteen months old, 
exhibited a similar depression of 0°.56C. ; while ten 
children, ranging in age from twenty months to four 
years of age, averaged 0°.34C. less when asleep than 
when awake. 

The well-known experiments of Chossat, who found 
that the temperature of pigeons was from 0°.70 C. to 
0°.90 C. higher at noon than at midnight, may not be 
considered satisfactory evidence of the depressing in- 
fluence of sleep, because it is true that the diurnal 
variations of temperature which are conditioned by 

1 Die. Encyc. des. Med., ie serie, t. XV, p. 75. 
* Handbuch der Kinder krankheiten, Vol. I, p. 383. 



8 INSOMNIA. 

the vital activities of every animal might be sufficient 
to account for these differences. The experiments of 
Horvath * are more convincing. This observer found 
that the marmots upon which he experimented were ac- 
customed to sleep during the winter for about four 
days continuously, and would then remain awake for an 
equal length of time. "During the sleeping period 
they can be cooled down to such a degree that a ther- 
mometer introduced into the rectum to the depth of an 
inch and a half indicated only 3°F. above the freezing 
point. The temperature rose rapidly after the animal 
awoke, so that in the course of an hour it was 3°F. 
higher; at the close of the second hour 9°F. higher, 
and at the end of the next half hour about 27 °F. * * 
Neither respiration nor the muscular movements were 
correspondingly augmented." This observation clearly 
shows the powerful influence of cerebral activity upon 
the liberation of heat within the body. 

Secretion. — The functions of the numerous glands 
throughout the body are diminished during sleep. 
The tears dry up, and the cornea receives less mois- 
ture. Hence the stickiness of the margins of the eye- 
lids during the sleep of a patient suffering with conjunc- 
tivitis. He can open his eyes, on awaking, only after 
sufficient time has elapsed to revive the lachrymal flow. 
Exner 2 remarks the diminution of pathological secre- 
tion in nasal catarrh during the hours of sleep. The 
mouth in like manner ceases to receive its full quota of 
saliva, and its cavity quickly dries if the lips remain 
open. The secretions of the gastro-intestinal glands 

1 Carpenter's Physiology ; 8th edition, p. 560. 

2 Handbuch det Physiologie, Vol. II, Pt. II, p, 297. 



EFFECT OF SLEEP ON NUTRITION. 9 

vary with the contents of the alimentary canal ; but in 
general they are considerably diminished, and diges- 
tion is correspondingly retarded during the hours of 
sleep. The quantity of urine is lessened during sleep. ' 
The elimination of urea and of other excrementitious 
matters is less during the night than by day. 2 Unless 
increased by disease, or by accidental circumstances 
connected with atmospheric temperature and unneces- 
sary clothing, the perspiration is also diminished. 

Nutrition. — All the molecular processes of nutri- 
tion are reduced by sleep. The lowering of the bodily 
temperature has been already indicated. The observa- 
tions of Helmholtz 3 indicate that the actual libera- 
tion of heat in the tissues is but little more than one- 
third of the amount set free in an equal period of time 
during the waking hours. The numerous experiments 4 
of Boussingault, Henneberg, Scharling, E. Smith, 
Liebermeister, Pettenkofer, Voit, and Lewin, clearly 
indicate the fact that during sleep less oxygen 
is absorbed, and less carbonic acid gas is dis- 
charged, by the tissues. Yoit found that while, 
during the daytime, 435 grammes of oxygen were 
taken in by a working man, only 321) grammes were 
needed by the same individual during the noctur- 
nal half of the day. Artificial sleep occasioned by 
chloral hydrate produced a similar reduction in the 
consumption of oxygen and in the formation of car- 

1 Quincke, Archiv. f. Experim. Pathol., Vol. VII, p. 115. 
9 Carpenter 's Physiology, 8th edition, p. 526, Handbuch der Kinder, 
krankheiten, 2d edition, Vol. I, p. 373. 

8 Die. Encyc. des Sci. Mid., Hie Serie, Vol. X, p. 268. 
4 Handbuch der Physiologie, Vol. V, p. 142-156. 



10 INSOMNIA. 

bonic acid gas. Under the influence of morphine 
the reduction of C0 2 . reached 27 per cent., and the 
diminution of oxygen amounted to 34 per cent, of the 
quantities furnished during wakeful activity. The 
comparatively small reduction (only 6 per cent.) in 
the decomposition of the nitrogenous elements of the 
body during the same period, exhibits the close rela- 
tion between the metamorphosis of the non-nitrogen- 
ous elements of the tissues and the amount of bodily 
activity. 

The experiments of Pettenkofer and Voit, to which 
allusion has just been made, serve also to illustrate the 
fact that all tissue changes are increased by every 
excitement of the sensory organs of the body, but are 
diminished by the subsidence of peripheral irritations. 
Hence the importance of quiet and darkness when we 
seek to induce that state of the body in which mole- 
cular processes should reach their minimum. Since 
every act of perception is attended by an outburst of 
refuse matter from the nervous tissue, the quantity of 
such excrementitious discharge in any given period of 
time becomes in some sort a measure of the vital 
activity of the organism. Conclusive proof of the 
diminution of vital function during sleep is thus ob- 
tained. 

It must not, however, be inferred that the general 
reduction of tissue-change, which has thus been estab- 
lished, during the hours of sleep, is evidence of a uni- 
versal and uniform reduction of function throughout 
the body. Sleep seldom falls at once with equal force 
upon every organ ; its invasion is progressive. Con- 
sequently, certain structures may be fast asleep, while 



STATE OF THE SPECIAL SENSES IN SLEEP. 11 

others are partly awake, — while still other portions of 
the organism may be in a condition of activity greatly 
in excess of their ordinary wakeful function. Upon 
this fact depend the phenomena of dreams and the 
various forms of somnambulism. The special senses are 
usually overcome by sleep before the muscular appa- 
ratus yields, and the cerebro-spinal nervous centres are 
the last of all to succumb. The eyes, for example, cease 
to see clearly before the eyelids droop, or the muscles 
of the neck give way in the act of nodding. The 
senses of touch and of taste fail next in order, as in 
the case of the infant gourmand, who may be seen 
falling asleep at supper, — his mouth yet filled with 
untasted sweets from the table before him. The sense 
of smell is more persistent, and its exercise is some- 
times an obstacle to the invasion of sleep. Witness 
the effect of powerful odors upon certain persons. The 
perfume of flowering plants in the sleeping chamber 
is sometimes decidedly annoying on this account. A 
lady of my acquaintance was once awakened out of a 
sound sleep by the smell of tobacco smoke from the 
pipe of a thoughtless burglar who had quietly entered 
a distant apartment of the house. A sudden change 
of wind, deluging a city with the vapors of a glue-fac- 
tory or rendering establishment, may in like manner 
disturb the slumbers of thousands of people. 

The sense of hearing seems to be the most persist- 
ent of all the special senses. It is not a very uncom- 
mon thing for persons to be awakened by the sound of 
their own snoring; or, if not actually aroused by the 
noise, to remain in a condition of repose which seems 
to be sustained and cheered by the regular rhythm of 



12 INSOMNIA. 

its own music. As a general rule, however, it is note- 
worthy that, when not wholly dormant, each sense 
finds its sphere of activity greatly narrowed by the 
fact of sleep. Consequently the range of perception, 
if not wholly obliterated, is greatly limited during the 
time of sleep. 

While it is true that sleep arrests the voluntary 
activities of the muscles, it is also a fact that all the 
muscles do not yield at once or in equal degree. The 
extensors of the neck, and the supporters of the spinal 
column, are the first to fail. The patient begins to 
nod, and is inclined to fall forward, before conscious- 
ness ceases. The muscles of respiration and of circu- 
lation continue to contract, though at a diminished 
rate. The vermicular movements of the intestinal 
coats persist, and in certain conditions of ill-health 
their exaggerated contractions may become a cause of 
imperfect repose. Reflex movements may always be 
excited during natural sleep. Tickling the sole of the 
foot will cause retraction of the limb; and before the 
complete establishment of sleep, a certain exaltation of 
the spinal reflexes may be observed. Young children 
may frequently be seen in the act of suction with their 
lips, as if at the breast; and the smile of the sleeping 
infant is a matter of daily remark in every nursery. 
The influence of dreams as an excitant of muscular 
movement will be hereafter discussed. 

The variation of intellectual function which appears 
in sleep serves to measure its profundity and to 
indicate the extent of its invasion. The act of per- 
ception being dependent upon sensation, it is to be 
observed that the range of perception diminishes so 



SLEEP AND THE MENTAL FUNCTIONS. 13 

soon as the organs of sense begin to yield. Its in- 
tensity may not immediately fail, but the breadth of 
its scope is narrowed. Sometimes, however, the act of 
conscious perception is arrested before the organs of 
sense are sealed. The sleepy reader may continue to 
eye the page before him, perhaps even to read aloud 
for a considerable time after he has ceased to derive 
any meaning from the words of the book. In such 
cases the organs of perception and conception and 
association of ideas slumber before the bonds of con- 
nection between the will and the muscular organs have 
been completely relaxed. Such an example affords a 
valuable illustration of the division of the brain into 
separate mechanisms which, though most intimately 
related, are nevertheless partially independent of each 
other. Sleep may operate like an invasive disease, 
falling with unequal incidence upon the different struc- 
tures that make up the mass of the brain, paralyzing 
one portion, while simply benumbing another, and even 
arousing to excessive activity a third. Consequently 
the intellectual functions may be very unequally dis- 
turbed, and the order of their subsidence may be con- 
siderably varied ; but, as a general rule, the physiologi- 
cal relations of the faculties are respected, so that as 
sensation diminishes, perception fails, the conception 
of ideas is correspondingly hindered, and the associa- 
tion of such ideas as are still projected upon the field 
of consciousness becomes more imperfect. The loss of 
the power of association implies the destruction of 
memory and the impossibility of exercising the rea- 
soning faculty or of forming those judgments upon 
which every act of volition is based. When the brain 



14 INSOMNIA. 

has at length been so far overwhelmed that physical 
impressions can no longer reach the field of conscious- 
ness, all manifestation of intellectual life is at an end, 
and the sleeper sleeps a dreamless sleep that leaves no 
trace behind. 

It is assumed in the last sentence that the brain 
may become so far transformed by sleep that it ceases 
for the time to be capable of function as the instru- 
ment of thought. This conclusion has been ques- 
tioned by the very highest authorities. Sir William 
Hamilton, Exner, and many others have instituted 
numerous experiments to test the possibility of a 
dreamless sleep. Causing themselves to be suddenly 
aroused at all hours of the night, they invariably found 
themselves at the instant of awaking occupied with the 
course of a dream. Hence it has been inferred that the 
mind is always alert, even when the body is most 
thoroughly asleep. In explanation of the fact that 
consciousness contains after deep sleep no trace of such 
mental activity, it is claimed that the act of dreaming 
of which we are aware at the moment of waking is 
proof of intellectual function during the moments which 
preceded that incident, and that we are merely forget- 
ful of all similar processes that occurred during undis- 
turbed sleep. The unconsciousness of sleep, according 
to this theory, is not real — it is only apparent through 
failure of the memory. If this be true, memory is the 
only intellectual faculty of whose inaction we can be 
sure. The period of deep sleep might then be, for all 
we know to the contrary, a period of the most intense 
and exalted mental activity. But, if so, it is quite 
worthless as a constituent of our conscious existence. 



MENTAL ACTION DURING SLEEP. 15 

It may also be objected with equal reason that the 
dreams which unquestionably occupy the field of con- 
sciousness at the instant of waking are probably ex- 
cited by the impressions which terminate sleep. The 
process of waking, though often very greatly hurried, 
is by no means absolutely instantaneous. As we shall 
learn, the time requisite for the evolution of a dream 
may be indefinitely brief. Consequently, it seems 
better in all such instances to assign the period of 
dreaming to the time of diminishing slumber that 
corresponds to the disturbance by which sleep was 
terminated. 

The only reason for any hesitation in the acceptance 
of such a proposition consists in the reluctance of many 
philosophers to admit the possibility of any interrup- 
tion in the active life of a spiritual being, such as man 
is conceived to be. But it is difficult to comprehend 
any valid reason for the denial of such interruption. 
Every form of force, of which we have any knowledge, 
is subject to fluctuations in the course of its phenome- 
nal manifestation. When a physical force ceases to 
exhibit itself in an active state, and passes into a poten- 
tial modification, we are not compelled to regard it as 
extinguished. It is merely latent or inhibited, but 
always ready to take its place again among the kinetic 
forces of nature. In like manner there seems to be no 
good reason why that spiritual force or congeries of 
forces which constitutes the mind of man may not 
experience analogous transformations in successive 
periods of action and of repose. Such periods of rest 
occur in sleep, in coma, in disease and disorganization 
of the brain. The mind sleeps, it does not cease to 



16 INSOMNIA. 

exist — probably not even when death dissolves its 
material substratum. 

That the depth of sleep is exceedingly variable is 
evident in the experience of every one. A German 
physiologist 1 has made a rough estimate of the 
soundness of sleep by comparing the loudness of 
the noises necessary to wake the subject of experi- 
ment at regular intervals during the course of the 
night. He arranged a gong with a pendulum attach- 
ment, and noted the length of the stroke which pro- 
duced a sound sufficiently loud to awaken the patient. 
In this way the different degrees of intensity of 
the awakening noise could be calculated, and the 
corresponding depth of sleep could be estimated. It 
was thus concluded that the depth of sleep increases 
rapidly during the first hour, at the end of which 
time it has reached its maximum. During the 
next half hour it diminishes as rapidly as it had 
increased in the first half hour. During the next 
hour it still further diminishes, almost as much as it 
increased during the second half hour. The remain- 
ing ten half hours of the experiment were occu- 
pied by a comparatively light and gradually diminish- 
ing slumber, until the vanishing point of sleep was 
reached at the expiration of eight hours from its 
commencement. This observation corresponds with 
the general opinion that sleep is deepest in the early 
part of the night. For the same reason dreams and 

1 Kohlschutter, Messungen der Festigkeit des Schlafes. Dissert. Leip- 
zig, 1862, und Zeitschrift f. rat. Med.. 1863. Quoted, Hermann's 
Handbuch der Physiologie, Vol. II, Pt. II, p. 295. 



THE CAUSES OP SLEEP. 17 

wakefulness are mosi frequent during the early 
watches of the morning. 

When considering the causes of sleep it is needful 
to exclude from view those artificial varieties of sleep 
that are produced by the various narcotic drugs, as well 
as the counterfeits of sleep which result from dis- 
eased conditions of the body. It is comparatively easy 
to frame hypotheses in explanation of such interrup- 
tions of our conscious life ; but, when we attempt to 
formulate a theory which shall satisfactorily account 
for the occurrence of natural sleep in healthy ani- 
mals, the task becomes exceedingly difficult. 

First among the causes of sleep may be reckoned 
the alternation of day and night. With the disappear- 
ance of sunlight all nature sinks into a condition of 

repose. 

' ' The night brings sleep 
To the greenwoods deep, 
To the bird of the woods its nest; 
To care soft hours, 
To life new powers, 
To the sick and the weary — rest! " 

In this tendency to nightly inaction man shares 
with all other living creatures. His body thus testi- 
fies to the intimacy of its relations with all portions of 
the solar system. Originated in the tropical regions 
of the earth, where day and night are nearly equal, 
we find in all parts of the world the same hereditary 
need of a period of rest, nearly coincident with the 
duration of the shorter nights of the tropical year. 
Had the birth-place of primeval man been situated 
within the Arctic circle, it is probable that his hours 
of sleep might have differed considerably from the 



18 INSOMNIA. 

number now needed by the average individual. So 
powerful are the necessities thus dependent upon the 
harmony between our organization and the movements 
of the earth, that if the habit be formed of sleeping at 
other hours than those which are usually devoted to 
that purpose, the full complement of sleep is still need- 
ful to satisfy the demand for rest. 

Prominent among the causes which predispose to 
sleep at night is the cessation of a majority of the sen- 
sations that are continually pouring in upon the brain 
during the period of daylight. Hence the necessity for 
seclusion in darkened rooms, from which the noises of 
the daytime are shut out, if one would sleep during the 
long days of the arctic summer, or if one would enjoy 
a midday nap at any season of the year. The close 
dependence of wakefulness upon the constant activity 
of the organs of sensation, is well illustrated by a case 
related in Hermann's Handbuch der Physiologie, Vol. 
II, Part 2, p. 295. A young man had been reduced by 
disease to such a condition of general anaesthesia that 
the right eye and the left ear were the only remaining 
paths of sensation between his brain and the external 
world. Whenever the sound eye and ear were band- 
aged so as to cut off all communication with the brain, 
the patient invariably fell asleep in the course of two 
or three minutes after the interruption of sensation. 
In like manner, some people, even in perfect health, 
are able to sleep at any time by simply lying down and 
closing the eyes. Such persons, however, are not often 
very highly gifted in the intellectual sphere. They 
generally belong to a class of men whose lives are 
laborious and liable to great irregularity and fatigue. 



THE CAUSES OF SLEEP. 19 

Such people labor in the open air, where every organ 
of sense is in a state of continual excitement. As 
soon, therefore, as they can find a quiet corner from 
which the commotion of the elements is excluded, it is 
only necessary to close the eyes — the principal avenue 
of communication with the outside world — and sleep 
begins at once. This is especially true if severe bodily 
exertion has preceded the opportunity for repose. 

Fatigue of any sort is one of the most energetic 
causes of sleep. The impossibility of long sustained 
exertion is a fact almost too familiar to attract atten- 
tion. Every muscle must be suffered to rest for a 
time after contraction before it can be again con- 
tracted. Even the heart and the muscles of respira- 
tion must be allowed to enjoy regular periods of repose 
many times each minute. These are examples of local 
rest, not involving the entire body. But if the whole 
body participate in any violent action, every part will 
manifest a consequent disposition to rest. Witness 
the effects of the venereal act. Every muscle is 
relaxed; the brain, which has officiated as the supreme 
source of energy, experiences exhaustion, and sleep 
frequently terminates the voluptuous paroxysm. In 
like manner, sensations of severe pain, if sufficiently 
prolonged, become a cause of sleep. Prisoners upon 
the rack have slept through sheer exhaustion while 
undergoing the horrors of torture. Little children 
frequently fall into a deep sleep immediately after 
painful, though comparatively bloodless, surgical op- 
erations performed without anaesthetics. The depress- 
ing emotions, even, may so fatigue the brain as to 
induce sound sleep through reaction from previous 



20 INSOMNIA. 

excitement. Every wearied portion of the body must 
rest; and when the brain thus rests, sleep is the con- 
sequence. 

Impressed by the force of such considerations, 
certain physiologists 1 have reasoned from the analo- 
gies suggested by a study of the results of mus- 
cular fatigue, and have suggested an hypothesis 
accounting for the occurrence of sleep by a sup- 
posed loading of the cerebral tissues with the acid 
products of their own disassimilation during wake- 
ful activity. The acid reaction of the brain and 
of the nerves after exertion, corresponding with the 
development of acids in the muscular tissues during 
contraction, suggested the probability that an excess- 
ive presence of lactic acid and its sodic compounds 
might be the real cause of cerebral torpor and sleep. 
Could this hypothesis be proved, ordinary sleep would 
take its place along with the states of unconsciousness 
induced by anaesthetics and hypnotics, and the lactate 
of sodium should be found the very best of medicines 
for the relief of wakefulness. Its administration for 
this purpose, however, has yielded only the most dis- 
cordant and unsatisfactory results. The fatigue the- 
ory, moreover, is insufficient, since it furnishes no 
explanation of the invincible stupefaction produced by 
cold, nor does it render intelligible the unbroken sleep 
of the unborn child. 

Far more comprehensive is the hypothesis advanced 

1 Obersteiner, Zur Theorie des Schlafes, Zeitschr. f. Psych. XXIX. 
Preyer, Ueber die Ursachen des Schlafes. Vortrag. Stuttgart bei Enke. 
1877, und centralbl. f. d. Med. Wiss. 1875.. S. 577. 



THE CAUSES OF SLEEP. 21 

by Pfltiger. 1 According to this view, the state of 
wakefulness is maintained by a certain degree of 
activity in the cortical substance of the brain. Like 
all other bodily organs, this substance is renovated by 
the assimilation of nutrient materials derived from the 
blood. By this process oxygen is stored up in chem- 
ical combination, forming " explosive compounds," 
whose precise composition is not fully understood. 
When for any reason the supply of oxygen is insuffi- 
cient, as in hemorrhage, producing cerebral anaemia, 
or in impregnation of the red blood corpuscles with 
carbonic oxide or chloroform, or other substances capa- 
ble of excluding oxygen from the hemoglobin of the 
corpuscle, the cerebral tissues are imperfectly reno- 
vated. The explosive constituents of the cortical pro- 
toplasm are then inadequately renewed after mental 
activity, and the sensitive portions of the brain are no 
longer fitted to manifest the highest forms of intelli- 
gent activity. But, when nothing interferes with 
healthy nutrition, the requisite degree of instability 
in the protoplasm of the brain is effected by intussus- 
ception of oxygen. Under the influence of the vari- 
ous nervous impressions which reach the brain, the 
unstable protoplasmic compounds break up into 
simpler forms. The motion thus liberated by these 
" explosions " of excitable matter is, in some way at 
present utterly inconceivable, projected upon the field 
of consciousness where the mind dwells ; and we are 
thus brought into conscious relation with the exter- 
nal world. 

That the capacity for thus signalling across the 

1 Theotie des Schlafes. Arch. f. d. ges. Physiol. X, 468. 



22 INSOMNIA. 

gulf which divides matter from mind is the result of a 
certain perfection and complexity of physical structure 
is rendered probable by the utter failure of the infra- 
cortical organs alone to impress the conscious intelli- 
gence by any amount of independent activity. The 
same thing is also indicated by the unconscious sleep 
of the rudimentary foetal brain, and by the brevity of 
the intervals of wakefulness which mark the life of the 
new born babe. That this capacity is dependent upon 
a special mobility of the atoms of the brain, is shown 
by the speedy cessation of intelligence which follows 
great reduction of temperature, as in hibernation, or 
during exposure to severe frost. That its exercise is 
largely dependent upon the activity of the senses is 
proved by interference with their function, as in the 
case above quoted (see p. 18) from the observations 
of Strumpell. 

The dependence of the waking state upon the pres- 
ence and activity of a sufficient quantity of a peculiarly 
unstable form of protoplasm in the brain is an hypothe- 
sis which presents no great difficulty of comprehen- 
sion. But how may we explain the lapse from the 
intelligent vivacity of that waking state into the un- 
conscious inactivity of sleep? I have elsewhere 1 dis- 
cussed the manner in which artificial sleep is produced 
by impregnation of the brain with anaesthetic sub- 
stances that interfere with sensibility, and finally pro- 
duce stupefaction, by hindering the normal processes 
of intra-molecular oxidation in the protoplasm of the 
nervous tissues. The same general line of argument 
may be extended to cover the action of every narcotic 

1 Artificial Ancesthesia and Ancesthetics, pp. 15-17. 



THE CAUSES OF SLEEP. 23 

agent with which the living substance of the body may 
become surcharged. Accepting, then, the hypothesis 
advocated by Obersteiner and Preyer, it becomes an 
easy thing to account for the gradual onset of sleep by 
supposing an accumulation of the " fatigue producing " 
products of intra-molecular oxidation. But we cannot 
thus explain the rapid and, as it were, voluntary pass- 
age from wide awakef ulness into a condition of deep 
sleep, such as may be commonly observed among sail- 
ors and others who have formed the habit of going at 
once to sleep at regularly recurring hours of the day 
or night. Certain writers have endeavored to account 
for this fact by imagining a special mechanism at the 
base of the brain (choroid plexuses of the fourth ven- 
tricle, etc.,) by means of which the current of the 
blood through the brain may be voluntarily dimin- 
ished, with a consequent arrest of conscious activity. 
But, still adhering to the hypothesis of Pfluger, we shall 
obtain a clearer explanation of the facts by considering 
the phenomena connected with the succession of impres- 
sions upon the organs of sense. It has been ascertained 1 
that such impressions must persist for a certain meas- 
urable length of time in order to excite conscious per- 
ception. A sound must be prolonged for at least f our- 
teen-hundredths of a second, a ray of light must agitate 
the retina for about eighteen to twenty-hundredths of 
a second, an ordinary contact with the surface of the 
skin must continue from thirteen to eighteen-hun- 
dredths of a second, in order to awaken any knowledge 
of sound and light and tactile sensation. For the 
simplest act of perception from two to four-hundredths 

1 Carpenter's Physiology, 8th ed., p. 852. 



24 INSOMNIA. 

of a second are necessary. It is, therefore, perfectly 
reasonable to suppose that when the " explosive ma- 
terial" of the brain has been sufficiently "dampened" 
by the accumulation of acid refuse which accompanies 
prolonged cerebral effort, the impressions of sense may 
no longer suffice to excite in the cortical protoplasm 
vibrations of sufficient length, or following each other 
in sufficiently rapid succession, to sustain conscious- 
ness. The cortex of the brain may then be likened to 
a body of water into which bubbles of partially soluble 
gas are introduced from below. When the bubbles are 
large, and when they follow each other rapidly, a con- 
tinual effervescence is maintained upon the surface of 
the water. But if the size of the bubbles be reduced, 
or if the solvent capacity of the liquid be increased, 
the surface will become almost, if not quite, perfectly 
tranquil. In some such way, without any great dan- 
ger of error, may we picture forth the manner in which 
the generation of ideas in the field of consciousness is 
related to the molecular movements in the space occu- 
pied by the protoplasmic substance of the brain. Re- 
turning, now, to the rapid induction of sleep, we find 
that it is usually the experience of people who lead an 
active life in the open air, and are compelled to endure 
frequent interruption of their rest. The sailor who is 
trained to work four hours on deck, and then to sleep 
four hours below, has been virtually transformed by 
this habit into a denizen of a planet where the days 
and the nights are each but four hours long. His 
bodily functions become accommodated to this condi- 
tion ; his nervous organs store up in sleep a supply of 
oxygenated protoplasm sufficient only for an active 



CEREBRAL ANAEMIA. 25 

period of four or five hours; so that, when the watch 
on deck is ended, he is in a state as well qualified for 
sleep as a laborer on shore at the close of a day of 
twelve or fifteen hours. Moreover, the majority of 
those who can thus easily fall asleep are individuals 
whose waking life is almost entirely sustained by 
external impressions. So soon, therefore, as such 
excitants are shut out by closing the eyes in a place of 
shelter from the sounds and turmoil of the air, com- 
paratively little remains for the stimulation of ordinary 
consciousness, and sleep readily supervenes through 
mere lack of cerebral excitement, especially if the 
excitable matter of the brain has been previously over- 
whelmed by the products of active exertion. 

That analogous, though not identical, predisposi- 
tion to unconsciousness may also be rapidly induced 
by modifications of the cerebral circulation is proved 
by the sudden reduction of cerebral excitability and 
consciousness which occurs during the act of fainting. 
In this counterfeit presentment of sleep the important 
part played by variations of the blood current through 
the brain is so conspicuous that certain writers have 
attempted to show that genuine sleep is the result of a 
diminution in the flow of blood to the cortex of the 
brain. An ingenious physician has even attempted to 
relieve insomnia very much as a surgeon might under- 
take to cure a popliteal aneurism — by placing tourni- 
quets on the arteries leading to the affected part. But 
the mere fact that syncope produces unconsciousness . 
does not prove that "cerebral anaemia" should be 
elevated to the rank of the principal cause of natural 
sleep. The nervous process is the primary factor. 



26 INSOMNIA. 

The circulation of the blood is everywhere under the 
immediate control of the nervous system. Conse- 
quently, every change in the condition of the nervous 
structures is followed by a corresponding change in 
the state of the circulating apparatus. Wherever an 
organ is aroused to activity, so delicate are the adjust- 
ments by which it is connected with the brain and with 
the heart that it is at once irrigated by an increased 
flow of blood. When its functional activity subsides, 
the same mechanism provides for a corresponding 
reduction in the supply of blood to its tissues. The 
brain itself forms no exception to this law. This has 
been admirably shown by the observations of Professor 
Mosso, of Turin. 1 The learned professor enjoyed the 
rare opportunity of observing three individuals who 
had suffered the loss of a considerable portion of the 
bony walls of the cranium, exposing the surface of the 
cerebrum, and affording a view of the pulsation of the 
vessels of the brain. With the aid of the cardiograph, 
the sphygmograph, the hydrosphygmograph, and the 
plethosphygmograph, it became possible to register 
the circulation of the blood in the brain, and to com- 
pare that portion of its course with the coincident cir- 
culation in other parts of the body. It was thus shown 
that every increase of emotional or intellectual activity 
was attended by an increase in the activity of the cere- 
bral circulation. This increase was procured at the 
expense of other portions of the body, which exhibited 
a coincident reduction in the amount of blood received 
from the heart. The occurrence of sleep caused a 

1 Stdla Circolazione del Sangue nel Cemello dell ' Uomo. Abstract in 
Brain, Vol. IV, p. ioo. 



CEREBRAL CIRCULATION IN SLEEP. 27 

diminution in the number of respirations, and a fall 
of six or eight beats in the pulse. The volume of the 
brain and its temperature were at the same time slightly 
reduced, through the diversion of blood from the head 
to other regions of the body. The consequent dilatation 
of the vessels in the extremities was readily demon- 
strated by the use of the plethosphygmograph. The 
extreme sensitiveness of the nervous centers was fur- 
ther illustrated by the fact that if, during sleep, a ray 
of light were directed upon the eyelids, or if any organ 
of sense were moderately excited without waking the 
patient, his respiration was at once accelerated; the 
heart began to beat more rapidly, the vessels of the 
extremities contracted, and the blood flowed more 
freely into the brain. Similar results accompanied the 
act of dreaming. The return of full consciousness on 
waking was followed by an immediate increase in the 
activity of the intra-cranial circulation. 

The extreme susceptibility of the brain to influences 
proceeding from artificial disturbances in the circula- 
tion, was exhibited in the case of one of Professor 
Mosso's patients. By compression of the carotid 
arteries, unconsciousness was induced, and an attack 
of convulsions was aroused. In no other part of the 
body can a corresponding disturbance of function be 
so quickly produced by similar means. A limb may 
be rendered bloodless for nearly half an hour, by the 
application of an elastic bandage, and yet its sensory 
nerves will remain capable of transmitting impressions 
from the periphery. But in this case, compression of 
the carotids for only eight seconds was sufficient to 



28 INSOMNIA. 

abolish consciousness and to excite convulsive move- 
ments. 

In all such observations it is worthy of note that 
the nervous impression is the primary event so long 
as artificial disturbances are not intruded. The 
changes of blood-pressure and circulation were inva- 
riably secondary to the excitement of nerve tissue. 
Sleep, therefore, must be regarded as the cause, rather 
than the consequence, of the so-called cerebral anae- 
mia which obtains in the substance of the brain during 
repose. This condition of " anaemia " is nothing more 
than the relatively lower state of circulation which 
may be remarked in every organ of the body during 
periods of inactivity. Every impression upon the sen- 
sory structures of the brain occasions a corresponding 
liberation of motion in those structures. The move- 
ment thus initiated arouses the vaso-dilator nerves of the 
cerebral vessels and excites the vaso-constrictor nerves 
of all other portions of the vascular apparatus. Hence 
the superior vascularity of the brain so long as the 
organs of sense are fresh and receptive. Hence the 
diminishing and varying vascularity of the different 
departments of the brain as sleep becomes more or 
less profound. These modifications of the brain and 
of its circulation are well illustrated by the effects of a 
moderate degree of cold applied to the cutaneous nerves 
of the body, as not unfrequently happens when the 
night grows cool towards morning. The disturbance 
of the sensitive nerves of the skin is transmitted to 
the brain. The excitement of this organ causes dilata- 
tion of its vessels, and increased irritability of the cor- 
tical instrument of perception. This becomes the 



THE CAUSE OF SLEEP. 29 

starting point for the projection of impulses upon the 
field of consciousness, producing dreams, or even a 
complete awakening from sleep. 

The cause of sleep must, therefore, be sought in 
the molecular structure of the brrdn, rather than in 
fluctuations of the blood-current. In the present state 
of our knowledge it must be negatively represented as 
the consequence of a deficiency in the amount of mov- 
able oxygen in the nervous tissue. This deficiency 
may be the result of immaturity, as in the foetus, or in 
the new-born infant ; or it may result from the accumu- 
lation of an excess of the waste-products of intra- 
molecular oxidation during functional activity — prod- 
ucts which hinder the further passage of oxygen into 
stable combination with the oxidizable elements of 
protoplasm. Sleep thus produced differs from the 
artificial sleep induced by narcotic drugs, in the fact 
that its cause is self -generated by the instrument of 
thought, while narcotic stupor is caused by the intru- 
sion of substances derived from without — substances 
which, like the natural refuse of the living cells, more 
or less completely hinder the processes of oxygena- 
tion and oxidation within the tissues of the body. 
Hence the states of healthy sleeping and waking must 
necessarily be self-limited and regularly successive; 
while the state of narcotism is purely accidental, and 
its duration exactly corresponds with the variable 
length of the period during which the body may re- 
main impregnated with the hypnotic agent. 

Certain morbid forms of sleep further illustrate its 
dependence upon the persistence of depression in the 
functional activity of the brain. For some persons 



30 INSOMNIA. 

this seems to constitute their normal condition. They 
are either excessively fat, red-faced, and soaked with 
beer, or they are pale, anaemic, and pulpy, with flabby 
muscles and a feeble circulation. They fall asleep 
whenever left to themselves, and never seem to be 
fully aroused to active life. The fat boy who figures 
so amusingly in The Pickwick Papers, furnishes a 
life-like picture of this variety of somnolence. 

The introductory stage of the eruptive fevers is 
often characterized by somnolence. It also frequently 
appears as the forerunner of coma in the various dis- 
eases which terminate in unconsciousness and death. 
A singular example of this has been observed among 
the negro inhabitants of the Atlantic coast of tropical 
Africa. The disorder is known to English writers as 
sleeping dropsy; by the French it is called maladie du 
sommeil. It is characterized by daily paroxysms of 
somnolence which tend to become more and more con- 
tinuous and profound until they are finally merged in 
fatal coma. For our knowledge of the disease we are 
chiefly indebted to the description by Clark, 1 an Eng- 
lish surgeon who practised in Sierra Leone, and to 
the monograph by Guerin, 2 a French naval surgeon, 
who had enjoyed exceptional opportunities for observa- 
tion among the laborers who had been carried from 
Africa to the island of Martinique. Similar cases have 
been occasionally reported in other regions of the 
world, but it is among the Africans' that it has been 
principally remarked. The onset of the malady is 

1 Transactions of the London Epidemiological Society, Vol. I, p. 1 1 6. 
* De la maladie du sommeil, 1869. 



MALADIE DU SOMMEIL. 31 

gradual, commencing with a slight frontal neadache. 
After a few days a disposition to sleep after meals is 
noted. This becomes increasingly urgent, and the 
intervals of sleep are prolonged until at length the 
patient becomes continually soperose. The waking 
periods are marked by a sluggish state of the intel- 
lectual faculties. The pulse is not accelerated, and it 
remains full and soft. The veins of the sclerotic are 
turgid, and the eyeball seems unusually prominent. 
The temperature does not increase, but rather tends to 
diminish its figure. The skin is dry and moderately 
cool. The tongue continues moist, and is covered with 
a white fur. The bowels and the bladder are regularly 
emptied, and the appetite persists with considerable 
vigor. Finally, the patient becomes completely coma- 
tose, and dies quietly. Sometimes, however, the evo- 
lution of the disease is less tranquil. Epileptiform 
convulsions, followed by progressively deepening 
periods of coma, interrupt its course, and a continuous 
muscular agitation marks the closing scene. At the 
same time the pulse grows weaker and more frequent 
until its movements cease in death. Kecovery is 
almost unknown, though the duration of the disease 
often varies from three months to a year or longer. 
Examination of the body after death yields very nega- 
tive results ; the sinuses and larger vessels of the brain 
are engorged with blood, but no evidence of inflam- 
mation is anywhere apparent. The other organs pre- 
sent no pathological alterations whatever. These 
observations seem to indicate that the disease origi- 
nates in some form of general blood-poisoning, rather 
than in any local inflammation or degeneration. Dr. 



32 INSOMNIA. 

Clark has called attention to an enlargement of the 
cervical glands as a feature of the malady. According 
to Dr. G. H. Bachelder, 1 the native physicians cure 
the disease by extirpation of the affected glands. He 
has also observed an initial lesion in the nasal mucous 
membrane. If this be confirmed, the malady will take 
its place among the forms of somnolence produced by 
infection of the blood. 

Between the profound unconsciousness of natural 
sleep and coma may be placed the distinction that the 
one is always the consequence of healthy physiological 
processes, while the other is always the result either of 
injury, of disease, or of some form of intoxication. 
Comatose unconsciousness may be the result of cerebral 
compression caused by injury of the head, or by the 
presence of an inflammatory exudation. Intra-cranial 
tumors, embolisms, thrombi, diseases of the cerebral 
arteries, and degenerations of the brain, — in short, 
every morbid change of which the liquids and the 
solids within the cranium are capable — may become 
the cause of coma. Toxsemic conditions of the cir- 
culating fluids of the body may benumb the brain with 
comatose sleep. Few diseases, therefore, exist without 
the possibility of coma as one of their consequences — 
a coma which, however, must not be confounded with 
the genuine sleep which sometimes occupies the larger 
part of convalescence from acute illness. During such 
convalescence there is a reversion to the infantile type 
of nutrition with all its need of prolonged and fre- 
quent periods of repose. Like normal sleep, the coma- 
tose condition admits considerable variation of inten- 

1 The Medical Record, July I, 1882, p. 23. 



LETHARGY. 33 

sity. The patient may sometimes be partially roused, 
as from the coma of alcoholic intoxication, and he may 
finally recover complete consciousness ; but very often 
the reverse is the fact. The coma deepens into 
paralysis of the respiratory centres, and death con- 
cludes existence without the slightest manifestation of 
sensibility or intelligence. 

Lethargy is a pathological variety of sleep, in which 
the repose of the body is even more complete than in 
coma. The victim of coma often presents a counte- 
nance suffused with blood ; the pulse beats vigorously, 
and respiration may become stertorous. But in lethargy 
the abolition of bodily movement is almost absolute. 
In the milder forms of this disorder the patient may 
be partially roused, so as to attempt an answer when 
addressed, appearing like a person in very deep sleep; 
but in the majority of cases he remains insensible, 
unconscious, and utterly irresponsive to ordinary forms 
of irritation. Kespiration and circulation are reduced 
to a minimum, and may, even for a time, become im- 
perceptible. Uncomplicated with hysteria, the dis- 
order is rapidly fatal, but, according to Rosenthal, 1 
hysterical lethargy is never mortal. 

Many examples of this disease have been afforded 
by the records of apparent death. I am well acquainted 
with a lady who, in early childhood, had been laid out 
for burial at the supposed termination of some infant- 
ile illness. Her mother alone insisted that the child 
was still alive. After some time spent in weeping and 
expostulation, she applied a blister to the thorax of 
the babe. This soon excited evidences of painful irri- 

1 Real. Encyc. derges. Heilkunde, VIII, 276. 
3 



34 INSOMNIA. 

tation, followed by a complete recovery. Still more 
instructive is the case, narrated by Rosenthal, 1 of a 
young woman, twenty-four years of age, who, in con- 
sequence of violent emotional excitement, became 
unconscious, and presented no signs of life, though 
tested by placing a mirror before the mouth, and by 
dropping melted sealing-wax upon the skin. On rais- 
ing her eyelids, the pupils gave no reaction to light; 
the limbs remained perfectly flaccid, and the radial 
arteries were pulseless. Careful auscultation, how- 
ever, detected a very feeble and intermittent sound in 
the cardiac region. The walls of the chest exhibited 
no movement, but the lateral surfaces of the abdomen 
presented a slow and almost imperceptible oscillation. 
Gentle faradization of the muscles and nerves of the 
face, arm, and hand, excited definite muscular contrac- 
tions. By this method Eosenthal became satisfied 
that, although the patient had remained for thirty-two 
hours in this condition, she was only apparently dead. 
In fact, after continuing forty-four hours in a state of 
suspended animation, she awoke spontaneously, made 
a rapid recovery, and seemed to enjoy as comfortable 
health as an excitable, nervous temperament would 
permit. 

Certain authors make a distinction between lethargy 
and apparent death ; but the difference is one of degree 
rather than of kind. The movements of respiration 
and of circulation, though greatly enfeebled, are read- 
ily observed in ordinary forms of lethargy; but in 
apparent death the pulse can no longer be discovered, 
and nothing more than the faintest sound can be dis- 

1 Op. cit. p. 276. 



LUCID LETHARGY. 35 

tinguished in the region of the heart. It, therefore, 
becomes important to have within reach a crucial test 
of the persistence of general vitality. Such evidence, 
according to Rosenthal, is furnished by the faradaic 
current. Within two or three hours after actual death, 
the muscles cease to respond to the induced current: 
but in apparent death this form of electro-muscular 
contractility never disappears. Every other test that 
has been proposed has failed under certain circum- 
stances. Observation of the changes in muscular tem- 
perature during electrical excitation is a method better 
adapted to the laboratory than for clinical practice. 

Lucid lethargy, — In certain cases of apparent 
death the patient exhibits all the external appearance 
of suspended animation, but the power of conscious 
perception does not cease. The senses of sight and 
hearing remain, and are, perhaps, intensified by inhi- 
bition of the power of voluntary movement. The 
sufferer sees and hears ; perception, emotion, memory, 
the power of reasoning, judgment, volition, all persist. 
Only the power of executing voluntary movements is 
lacking. 

The victims of this variety of apparent death are 
usually women, or men who are characterized by a 
feminine nervous organization. Great mental excite- 
ment, fatigue, semi-starvation, and exhausting diseases, 
are the principal exciting causes of the event. The 
following case, related by my friend, Dr. P. S. Hayes, 
of Chicago, illustrates the phenomena of lucid leth- 
argy. The patient was a female physician, about 
thirty years of age, unmarried, and consumptively 
inclined. During the course of a long and wearisome 



36 INSOMNIA. 

hospital service, she was prostrated with typhoid fever. 
Placing herself under the immediate care of my inform- 
ant, she was also attended by several of the most emi- 
nent physicians in the city. After a long and exhaust- 
ing illness she appeared to be dying. In the presence 
of her physician, and surrounded by her relatives, she 
ceased to breathe. The pulse stopped, life seemed to 
have gone out. Bottles of hot water were applied to 
the limbs, and various restoratives were employed. 
After a considerable time she began again to breathe, 
and a gradual recovery followed. During the whole 
time of apparent death, consciousness had been pre- 
served. She seemed to be looking down from a point 
above her bed ; she could see the doctor feeling for her 
pulse, and was grieved by the sorrow of her friends. 
Ordinary sensation was temporarily suspended, and 
she could not distinguish the contact of the hot-water 
bottles that were applied to her limbs, though actually 
scalded by their excessive heat. Borne upon the 
wings of an excited imagination, she thought herself 
permitted to look into heaven, but was not suffered to 
enter its gates. In this exaltation of the imagination 
the reasoning faculties also shared, so that certain 
philosophical problems which had previously baffled 
her intellect were now perfectly comprehensible, 
and the memory of their solution persisted after 
recovery. 

Many similar narratives have been duly authenti- 
cated, but the limits of the present chapter will not 
permit a discussion which properly belongs to an 
investigation of the phenomena of trance. The im- 
portant fact for present consideration is the persist- 



LUCID LETHARGY. 37 

ence of conscious life, despite the appearance of death. 
In this preservation of consciousness, notwithstanding 
the temporary suspension of certain kinds of sensibil- 
ity and the power of voluntary motion, may be discov- 
ered a relationship between the phenomena of lucid 
lethargy and various disturbances of sleep, which will 
be considered in a succeeding chapter. 



CHAPTEE II. 

INSOMNIA, OR WAKEFULNESS. 

Sleep, gentle sleep, 
Nature's soft nurse, how have I frighted thee 
That thou no more wilt weigh mine eyelids down 
And steep my senses in forgetfulness? 

—King Henry IV, Second Part. 

We have seen that the condition of normal sleep is 
determined by a peculiar molecular state of the sub- 
stance of the brain — a modification regularly alternat- 
ing with that by means of which the condition of 
wakefulness is sustained. We have also seen that 
sleep is liable to variations in its intensity, and that its 
course may be partially interrupted by dreams, or even 
by a more or less complete resumption of the move- 
ments of locomotion, constituting the different varieties 
of somnambulism. Our attention must now be directed 
to the consideration of those greater disturbances of 
sleep which either serve to prevent its full develop- 
ment, or else to actually interrupt its course, rendering 
it incomplete and fragmentary, or even abolishing it 
altogether. But, inasmuch as the healthy brain, when 
associated with a healthy body, can only by an extra- 
ordinary effort of the will be kept awake beyond a cer- 
tain period, and then only for a short time beyond the 
ordinary interval of wakefulness, it follows that the 
study of the usual causes of insomnia must be an in- 

(38) 



CAUSES OF INSOMNIA. 39 

vestigation of morbid conditions of the bodily func- 
tions. Sleeplessness, therefore, must result, 1st, from 
a disturbance of the peripheral sensory organs of the 
nervous system; 2nd, from disordered conditions of 
the sensory nerves and nerve tracts ; 3rd, from morbid 
states of the brain; 4th, from any or all of these con- 
ditions operating in association with each other. We 
may, therefore, consider, I, Insomnia caused by irrita- 
tion of the peripheral j tortious of the sensory apparatus; 
and, II, Insomnia caused by morbid states of the central 
nervous organs, 

I. Insomnia caused by irritation of the peri- 
pheral PORTIONS OF THE SENSORY APPARATUS. 

Irritation of the sensory apparatus may be ranked 
in three classes: 

1. Affections of the organs of special sense. 

2. xlffections of the nerves of common sensation. 

3. Affections of the sympathetic nerves. 

1. Affections of the organs of special sense. — Promi- 
nent among these is the effect of light upon the eye. 
The darkness of night favors sleep; the presence of 
light hinders its incidence and renders it less pro- 
found. During the gloom of a total eclipse animals 
seek their shelter; birds hide themselves in their nests; 
domestic fowls arrange themselves upon the roost, and 
seem quite disconcerted by the speedy return of sun- 
light. Children often find it difficult to sleep in an 
illuminated room. I have known nurses who would 
sit with a wakeful infant under a powerful gaslight till 
after midnight, and then would express their surprise 
that the baby persisted in gazing at the flame instead 
of going quietly to sleep. The inhabitants of North- 



4:0 INSOMNIA. 

ern Europe find it necessary to darken their sleeping 
rooms during the long polar day ; and travelers in such 
regions often suffer for want of the natural sleep which 
only darkness affords. Judge Caton, writing of his 
travels in Norway 1 says: "We longed for darkness 
and for night. Do what we could to darken the win- 
dows to keep out the light, still it was not night as 
nature makes it, and which the habit of a lifetime had 
rendered necessary to sound repose. Artificial dark- 
ness, especially when incomplete, is as far from night 
as artificial light is from day. . . . These sunny 
nights can hardly conduce to health, they steal away 
so much of sleep. One does not readily get sleepy in 
the sunshine, and then we are so apt to forget to look 
at the watch to see if it is time to retire." 

In the tropical regions of the world it is usual for 
the inhabitants to sleep during the middle of the day; 
but they take great pains to exclude the light from 
their houses during the hours of sleep. The Pacific 
Islanders cover their faces with the bed clothes for the 
purpose of excluding the light while attempting to 
sleep. Repose thus obtained in the daytime often 
serves to convert the night into a season of wakeful- 
ness. The Africans sleep and dream away the heated 
hours of the day, and give up considerable portions of 
the night to festivity in the open air — a practice which 
undoubtedly contributes to the permanence of an in- 
ferior grade of social life. 

Sudden illumination of the sleeping room will fre- 
quently awaken the sleeper. During the great fire in 
Chicago, A. D. 1871, many persons were thus aroused 

1 A Summer in Norway, by John Dean Caton, pp. 251 and 311. 



EFFECTS OF NOISE. 41 

from their slumbers as the flames lighted up the streets 
adjoining their houses. One of my acquaintances was 
awakened one night by a flash of light from the lan- 
tern of a burglar who was moving noiselessly about 
her chamber. The experience of almost every one will 
testify to the effects of sheet-lightning silently illumi- 
nating the sky by night. Dreams, also, are not unfre- 
quently excited by the incidence of light upon the 
closed eyelids. 1 

The sense of hearing is one of the most persistent 
of the special senses during the incidence of sleep. It 
is perhaps the most excitable of these senses during 
the period of repose. Long after the subject has be- 
come immersed in sleep his auditory apparatus remains 
sensitive to sounds. Dreams are often produced by 
impressions upon the ear. Often in sleep it seems as 
if the sense of hearing remained wakeful and watchful 
for expected signals, as when an alarm clock serves to 
arouse the sleeper at an appointed hour. Sometimes 
the sleeper may be shaken and tumbled about in his 
bed without waking, but if he be addressed by name 
he will usually reply. It is scarcely probable that the 
auditory apparatus is any more wakeful than other 
portions of the nervous system, but its external por- 
tions remain during sleep more completely exposed 
and adapted to the reception of impressions than is 
possible for the eye and for the organs of touch and 
taste. 

The persistent sensitiveness of the ear during 
sleep is not so much a capacity for noticing sounds 
as a sensibility to variations in sonorous impressions. 

1 A. Maury, op. cit. , p. 156. 



42 INSOMNIA. 

Thus a steady and monotonous noise may, if long con- 
tinued, serve to render one sleepy; but the sudden 
cessation of the same sound will awaken every one. 
Slowly lulled to sleep by the incessant rumble of the 
engine upon one of the old-fashioned Long Island 
Sound steamboats, how immediate the awakening of a 
whole cabin full of people, when the wheels were sud- 
denly stopped! A recent traveler in Guiana 1 relates 
a curious experience with an Indian magician who un- 
dertook to cure him of a slight headache and fever. 
The method of cure consisted in placing the patient at 
night in his hammock, wtrile the magician kept up a 
hideous succession of yells and shouts, shaking the 
walls and roof of the house with an uproar which never 
ceased for six hours. Before long the patient passed 
into a kind of fitful sleep or stupor, during which he 
seemed to be suspended in a surging ocean of sound. 
When the noise died away, as if growing fainter in 
the distance, he would rouse up into a semi-conscious 
state, but when it again increased he would fall back 
into stupor. At last, when the noise finally ceased, he 
awoke completely, but without the slightest relief 
from headache — an experience quite illustrative of 
the manner in which the brain may be affected by 
sound. 

It is not often that the sense of smell becomes the 
avenue of impressions that interfere with sleep. So 
different are the capacities of individuals in this par- 
ticular that an odor which might severely annoy one 
person, would pass almost unnoticed by another. 
Large cities are sometimes invaded by overwhelming 

1 Among Die Indians of Guiana. By Everard F. Im Thurn. 



EFFECT OF ODORS, SAVORS, AND HEAT. 43 

stenches from the various factories which spring up in 
their neighborhood. While it is seldom true that the 
vapors discharged by such establishments are directly 
deleterious to health, they may become indirectly a 
cause of ill-health through the wakefulness occasioned 
by them among weakly invalids. The smell of smoke 
in a bed-chamber sometimes serves to awaken a sleeper, 
giving warning of the outbreak of a fire in the build- 
ing. Less energetic odors may disturb the depth of 
sleep without actually waking the patient. Thus 
Maury records 1 that when he was made to inhale the 
vapor of cologne water while asleep, he dreamed of be- 
ing in the shop of a perfumer. 

Excitement of the sense of taste would, doubtless, 
operate in a similar manner; but it is so difficult to 
arouse this sense without at the same time irritating 
the nerves of common sensation about the mouth, that 
very little can be said regarding the matter. Dreams 
of gustatory sensations are usually of subjective 
origin, dependent upon some reflex movement, or 
upon some agitation of the organ of memory, within 
the brain. 

If, with Sir William Thompson, 9 we recognize, a 
sixth sense — the sense of temperature — it must be ad- 
mitted that through the varying sensations of heat and 
cold, sleep can be greatly disturbed. Every one will 
recall to mind the story told by Dugald Stewart, of a 
gentleman who dreamed of walking over heated lava 
on Mt. iEtna when a bottle of hot water was placed 
against his feet, in bed, on account of some slight 

' Le Sommeil et les Reves, p. 154. 
■- .Vature, Vol.' XXIX, pp. 438-462. 



44 INSOMNIA. 

indisposition. The temperature of the air is one of 
the most important factors in the determination of 
sleep. A high temperature keeps every one awake — 
a fact well known among the unfortunate denizens of 
the garrets in our great cities. Not only is wakeful- 
ness the direct result of heat, but it is aggravated and 
embittered by the accompaniments of a torrid climate 
— insects, foul air, and cutaneous disorders. In the 
East Indies, so difficult is sleep under such conditions 
that the wealthy inhabitants compel their servants to 
cool them all night with the punkah, a large, swinging 
fan, suspended above the bed, and kept in motion by 
means of a cord leading outside of the bed-room to the 
verandah, where the punkah-wallah sits and pulls the 
string while his master sleeps. So powerful is the 
force of habit in the organization of the automatic ap- 
paratus of the body that, though these punkah-pullers 
often fall asleep, they still continue, without interrup- 
tion, the successive movements by which the fan is 
kept in operation. 

The evil effects of a high temperature are greatly 
aggravated by the presence of humidity in the atmos- 
phere. Dampness interferes with the process of ex- 
halation from the surface of the body, which, conse- 
quently, tends to become overheated. The tissues, 
under such circumstances, are imperfectly defecated, 
and rapidly pass into a condition of imperfect nutri- 
tion. This depresses all the functions of the body, 
and renders the nervous system inordinately irritable. 
Sleep cannot be profound and refreshing, because of 
the over-excitable state of the brain. During the long, 
hot season in tropical countries, it often becomes nee- 



RELIEF BY COOL AIR. 45 

essary to seek a temporary retreat among the high- 
lands and mountains, in order to find a climate suffi- 
ciently dry and cool to furnish the condition for 
refreshing sleep. For the same, reason many of the 
inhabitants of the Southern United States are forced 
to spend the summer months in the invigorating 
atmosphere of Minnesota and Northern Michigan. 
One of the most delightful of experiences may be pro- 
cured on any warm day in summer by embarking, at 
Chicago, upon one of the steamboats bound to Macki- 
nac. At the wharf, in the hottest and dirtiest part of 
the city, all is dust, perspiration, and discomfort. The 
wide cabins are filled with people who are tired, thirsty, 
and discouraged. Sickly, squalling babies swarm in 
numbers sufficient to drive one mad. As the sun goes 
down, the signal-whistle sounds, head-lines and stern- 
lines are quickly cast off, the propeller churns the 
mire behind the boat. Slowly swings the huge fabric 
away from the shore, gliding between the walls of sun- 
scorched brick that line the stream on either side. 
At last the light-house at the mouth of the river is 
passed, and we are out upon the blue waves of Lake 
Michigan, with a heavenly breeze searching every 
crack and cranny of the hull. New life animates every 
form, and presently a great silence pervades the bril- 
liant cabins. The children have left their woes be- 
hind, and, for the first time, in many weeks, perhaps, 
they and their weary mothers sleep the sleep of inno- 
cence and peace. 

The dependence of a high atmospheric temperature 
upon the direction of the wind renders the course of 
the aerial currents a matter of great importance in 



46 INSOMNIA. 

relation to sleep. The southerly winds which, in the 
northern hemisphere, are hot and enervating, always 
produce an increase of wakefulness. The winds that 
blow from the heated deserts of Africa, Arabia, and 
Australia, are greatly dreaded upon this account, as 
well as for the other numerous discomforts which fly in 
their train. Their cessation, and their replacement by 
a cool, polar current brings relief at once. The changes 
thus produced in the electrical condition of the atmos- 
phere doubtless contribute more than is usually known 
to these results. A cloudless sky gives evidence of 
positive electricity, which is much stronger in winter 
than in summer. 1 Clouds are sometimes positive and 
sometimes negative. According to Fonssagrives 2 the 
atmospheric electricity is positive during northerly 
winds, and negative during the prevalence of winds 
from the southerly quarters of the horizon. Great 
disturbances of the electrical condition of bodies is 
often observed during the occurrence of the sirocco in 
North Africa. Arago has related the case of an officer 
in the French army 3 who saw sparks of electricity 
leaping from his epaulettes at every blast of the sirocco 
encountered on a march in the neighborhood of Algiers. 
Such atmospheric disturbances often produce very dis- 
agreeable effects upon persons of a nervous tempera- 
ment. According to Fonssagrives (loc. cit.) such 
patients frequently experience, during the prevalence 
of storms which traverse great distances, a high de- 
gree of insomnia, together with headache, pains in the 

1 Gemot* s Physics. 

2 Die. Encyc. des Set. Mid. , Art. Climat. 

3 Comptes-rendus Acad, des Sci., 1840, t. XI, p. 823. 



EFFECTS OF COLD. 47 

limbs, joints, and old injuries, and a general indefinable 
sensation of discomfort. S. Weir Mitchell has care- 
fully traced the connection between these phenomena 
and the variations of barometric pressure which accom- 
pany the revolving storms that cross the continent in a 
northeasterly direction. 1 

Though the effect of a high atmospheric tempera- 
ture is unfavorable to sleep, an excessive temperature 
produces the opposite condition. Stupor rather than 
sleep is the consequence of insolation and of exposure 
to great heat from artificial sources. This is a patho- 
logical process, and, therefore, must not be mistaken 
for natural sleep. It may result either from cerebral 
congestion, or from cardiac exhaustion, and is character- 
ized by an extraordinary bodily temperature and a high 
rate of mortality. 2 So elaborate are the arrangements 
for the preservation of a uniform temperature through- 
out the body that it is practically impossible for a sun- 
stroke to occur unless the regulative apparatus has 
been previously deranged by ill-health. 

Excessive cold operates in like manner to produce 
a condition of stupor that tends to a fatal termination. 
But moderate degrees of cold act as excitants of wake- 
fulness. By effecting a contraction of the vessels of 
the skin cutaneous circulation is impeded. The venous 
side of the circulatory apparatus becomes overloaded 
with blood; the exhalation of carbonic acid and the 
production of heat are reduced. The discomfort that 
results from this disturbance of the natural functions 

x Am.Journ. Med Set., April, 1877, p. 305. 

2 A remarkable illustration of this will be found related in The 
Lancet, July 26, 1884, p. 112. 



48 INSOMNIA. 

of the tissues is sufficient to arouse the brain to wake- 
fulness, just as an imperfect oxidation of the blood 
serves to excite the respiratory centre in the medulla 
oblongata. It is hardly necessary to allude in this 
connection to the increased flow of blood through the 
brain occasioned by this as by every other excitement 
of the sensorium. Local refrigeration of any portion 
of the body thus acts as a painful excitant of the cere- 
brum, and produces wakefulness, very much as disten- 
tion of the intestines with gas will keep one awake. 
It is for this reason almost impossible to sleep with 
cold feet. Conditions of this sort are pathological, 
and are far in excess of the agreeable coolness which 
favors sleep. The effects of progressive diminution of 
the temperature of the air are well illustrated by the 
hibernation of animals. 1 As the temperature of the 
air diminishes, in winter, animals like the marmot fall 
into a species of sleep. Their movements of respira- 
tion and circulation are greatly reduced, and their 
bodily temperature falls, though it always remains 
several degrees above the temperature of the surround- 
ing air. So long as the average degree of cold is 
maintained, the little creature sleeps naturally ; but, if 
the air becomes extraordinarily cold, the physiological 
repose of the animal is disturbed. It becomes uneasy, 
wakes up, and seeks a warmer retreat Too great a 
degree of cold thus becomes a cause of wakefulness. 
If the animal under these circumstances fails to secure 
protection against a falling temperature, it passes into 
a state of lethargy that is often fatal — a pathological 
condition being substituted for the physiological sleep 

1 Die. Encyc. des Set. M/d., Art. Froid, p. 139. 



SENSORY DISTURBANCES 49 

of ordinary hibernation. In like manner the human 
animal may experience the threefold effects of refrig- 
eration : first a pleasing coolness that favors sleep ; then 
an uneasy sensation of cold which causes wakefulness; 
and, finally, a lethargy that paralyzes all the functions 
of the body and terminates in death. 

2. Affections of the nerves of common sensation. — 
Chief among the causes of sleeplessness thus produced 
is pain. This is a modification of feeling, caused by 
excessive or extraordinary excitement of the peripheral 
nerves of sensation. The seat of the excitement may 
be in the skin or in the deeper tissues of the body. 
Cutaneous pain may be caused by the activity of 
various insects, like flies, mosquitos, fleas and bed- 
bugs, or by the presence of certain parasites, such as 
the itch-mite, or by ordinary diseases of the skin, of 
which notable examples are found in erysipelas, ery- 
thema, urticaria, lichen, prurigo, certain varieties of 
eczema and psoriasis. The troublesome forms of 
pruritus which accompany icterus, or which may occur 
without any clearly defined cause, are frequent causes 
of wakefulness. The last mentioned disorder must, 
however, be sometimes recognized as a consequence of 
central nervous disorder, rather than a result of peri- 
pheral disease. Witness the frightful itching some- 
times experienced during the progress of chronic 
myelitis. All kinds of injuries, wounds, ulcers, and 
other local inflammations are common causes of in- 
somnia by reason of the painful impressions trans- 
mitted from them to the brain. Hence the great 
importance of anodynes and hypnotic remedies in the 
course of surgical practice. Diseases or injuries of 
4 



50 INSOMNIA. 

the various peripheral nerves are notable causes of 
sleeplessness. Witness the horrible wakefulness 
caused by neuritis and by neuralgia. The develop- 
ment of neuromata in the stumps of amputated limbs 
may thus become a most painful cause of insomnia. 
Inflammations which encroach upon sensitive nerves 
produce intense pain with consequent loss of sleep. 
Of this very conspicuous examples are furnished by 
spinal meningitis, and by the effects of local periostitis 
causing compression of the branches of the fifth pair 
of nerves. 

3. Affections of the sympathetic nerves. — So much 
still remains to be learned concerning the pathological 
functions of the sympathetic nerves that it is impossi- 
ble to assign with any great degree of precision the 
exact amount of interference with sleep that may de- 
pend upon disordered conditions of this portion of the 
nervous system. Since their principal functions con- 
sist in the regulation of the flow of blood and lymph 
throughout the body, and in the control of the pro- 
cesses of nutrition, calorification, secretion and excre- 
tion, it follows that any considerable derangement of 
their healthy action must be represented by a cor- 
responding disturbance of the brain. This may reach 
the field of consciousness in the form of pain, and thus 
may become a cause of sleeplessness. In all the phe- 
nomena of inflammation sympathetic nerves play an 
active part. In certain portions of the body, as in the 
principal viscera, and in the periosteal covering of the 
bones, they are the interstitial nerves of the structures. 
When the body is in a healthy condition these nerves 
convey impulses of a sensory character which do not 



MORBID STATES OF THE NERVOUS SYSTEM. 51 

reach the cerebral organ of conscious sensation. But 
in certain morbid states they become inordinately sen- 
sitive, and they then serve to convey and probably also 
to magnify sensations to an extent that may cause 
exquisite pain with all its consequences. Witness the 
pain experienced during the various forms of colic. 
Eheumatic inflammations, pleurisy, pericarditis, peri- 
tonitis, cystitis, metritis, ovaritis, gastro-enteritis, and 
other similar diseases owe their principal suffering to 
the affection of the sympathetic nerves connected with 
the respective organs which become the seat of pain. 
Including with the sympathetic nerve the pneumo- 
gastric nerve, which occupies a functional position 
between the strictly peripheral and the ganglionic 
nerves, all the various forms of pain and uneasiness 
experienced in the region of the heart and of the lungs 
may be assigned to this system of nerves. Thus the 
various species of respiratory disturbance, such as 
asthma and dyspnoea from any cause, and the forms 
of palpitation and other cardiac disorder may become 
causes of wakefulness. In like manner the vague and 
uneasy sensations associated with certain varieties of 
dyspepsia are frequent sources of sleeplessness, not 
merely by reason of the pain which they occasion, but 
also because of the general disorders of nutrition with 
which they are associated. 

II. Insomnia caused by morbid states of the cen- 
tral NERVOUS ORGANS. 

So intimately connected are the spinal cord and the 
brain that their disorders may properly be considered 
together. These may be classified as: 

1. Disorders of circulation and nutrition. 



52 INSOMNIA. 

2. Inflammations and degenerations. 

3. Neoplastic encroachments. 

Disorders of circulation and nutrition. — Hyperemia 
of the brain is a frequent cause of wakefulness. This 
may be maintained by an unconscious effort of the 
organ of the will under the influence of any great and 
unusual excitement of the mind. So soon as the men- 
tal excitement is allayed, the excessive afflux of blood 
subsides, and the brain becomes fitted for sleep. But, 
if excitement be too far prolonged, the nutrition of the 
nervous centres suffers, and the regulative apparatus 
of the cerebral circulation becomes exhausted, so that 
the brain cannot rest, because its inhibitory centres 
have lost their power of control over the lower ganglia 
of the organ. The cerebro-spinal centres are then in 
a condition analogous to that of a locomotive engine 
on which the engineer can no longer regulate the pro- 
duction and distribution of steam. Such a condition 
is usually the result of numerous antecedent causes. 
Long hours of work, scanty Or improper food, insuf- 
ficient sleep, bad hygienic surroundings and habits, 
with indulgence in the use of narcotics and stimulants, 
are among the most common causes of the disorder. 

Active hyperemia of the nervous centers has been 
above mentioned as the consequence of cerebral func- 
tion under unfavorable conditions. But, as the disor- 
der persists, its type undergoes a change. We still 
speak of the disorder as functional in its character, but 
it continually tends to become organic. No visible 
alterations, perhaps, can be detected, but, evidently, 
there are radical changes in the substance of the nerv- 
ous tissue. Nutrition suffers throughout the body to 



IRRITABILITY OF THE BRAIN. 53 

a degree that attracts attention. The blood diminishes 
in quantity and quality, till the patient becomes nota- 
bly anaemic. In this condition the brain is inordinately 
excitable. It is incapable of sustained activity, and 
the patient may even be oppressed by an inclination to 
constant drowsiness; yet he will be unable to sleep 
soundly, and his sleep will be continually agitated by 
dreams. This state is one of the constant accompani- 
ments of slow starvation. The molecular structure of 
the nervous organs seems to be so slightly constructed, 
under such circumstances, that its equilibrium is dis- 
turbed by the most trifling incidents. It may be 
likened to a lofty wall of bricks laid up without mor- 
tar — "if a fox go up," the entire structure may be 
thrown down with a trentendous noise. Thus the 
anaemic and irritable brain will react excessively under 
the slightest impression; consciousness is invaded by 
perceptions which would never arise under normal con- 
ditions of the nervous tissue ; and the mind is continu- 
ally aroused. This form of wakefulness is very fre- 
quent among women who have become anaemic, and 
among patients who are slowly convalescing from 
exhausting diseases. 

It is impossible in every instance to decide whether a 
given state of wakefulness is the result of cerebral hy- 
persemia or anaemia. In the one case the persistence of 
wakeful activity of the mind is due to excitement of the 
cerebral cells, accompanied by a lavish irrigation of 
their substance with the plasma of the blood. In the 
other case the excitement is occasioned, not so much 
by increased afflux of the blood, as by a morbid insta- 
bility of the nervous substance. The outcome in both 



54 



INSOMNIA. 



cases is very similar — mental excitement and wake- 
fulness. 

In a third class of cases the agitation of the brain 
is produced by the direct action of certain chemical 
agents upon the cortical substance. Tea and coffee 
are familiar examples of such agents. The caffeine, 
by virtue of which they produce their effect, when 
transported to the brain, enters into combination with 
its protoplasm in such a way as to stimulate molecular 
movement. Perception is thus quickened, and the 
mind is aroused. Sleep is postponed until the effect 
of the stimulant has subsided. This form of wakeful- 
ness is quite different from that produced by alcoholic 
drinks. These operate, when taken in small quanti- 
ties, to favor cerebral equilibrium — and consequent 
equanimity — by producing a general dilatation of the 
smaller blood-vessels. Their anaesthetic influence is 
favorable to sleep, under such circumstances. But, if 
frequently repeated, these doses of alcohol modify the 
nutrition of the nervous system until, at last, a condi- 
tion of irritable weakness is reached, in which 
wakefulness of a most distressing character is expe- 
rienced. 

Inflammations, degenerations, and neoplasms. — The 
early stages of inflammation involving the central nerv- 
ous organs are marked by that form of insomnia whicli 
is associated with active hyperemia. The headache 
and painful delirium which accompany the different 
varieties of meningitis, are causes of a wakefulness that 
persists until the brain is merged in the coma of com- 
pression. The interstitial changes which cause the 
various forms of insanity, are in like manner causes of 



MAL- NUTRITION OF THE BRAIN. 55 

wakefulness. Local injuries and degenerations of 
brain-substance, tubercular deposits upon the menin- 
gies, and all the different forms of intra-cranial tumor, 
are causes of wakefulness, both by reason of the direct 
irritation which they produce, and by reason of the 
circulatory disturbances which arise in their neigh- 
borhood. 

Finally, it must be observed that wakefulness may 
result from excitement of the brain by irritating sub- 
stances transported through the blood from distant 
centers of disease in remote organs of the body, or 
derived from articles that have been absorbed with the 
food and drink, or with the air that enters the lungs. 
Thus wakefulness may accompany cutaneous disorders 
that interfere with perspiration. Imperfect elimina- 
tion through the liver, kidneys and intestines, leaves 
the blood charged with excrementitious substances 
which arouse the brain to wakefulness. In like man- 
ner, various poisons, like lead, arsenic, etc., different 
miasms of telluric origin, the products of putrefaction, 
and the various animal contagia, may produce insom- 
nia by their prejudicial effect upon the nutrition of the 
nervous structures throughout the body. 



CHAPTEE III. 

REMEDIES FOR INSOMNIA. 

O, true, apothecary ! 
Thy drugs are quick. 

— Romeo and Jttlibt. 

An occasional attack of wakefulness may fall to the 
lot of any one as a consequence of the various disturb- 
ances of health or equanimity of mind to which all 
are liable. Occurring as an accident in a state of 
health, it produces merely a feeling of lassitude and 
weariness during the subsequent day. This soon dis- 
appears, after a night of refreshing sleep, and the 
subject is nothing worse for the incident. But the 
recurrence of the disorder is a thing to be deprecated, 
not only for the reason that it denotes a departure from 
the physiological order of life, but because its frequent 
repetition prevents the adequate repair of the tissues 
of the body. The great function of nutrition suffers 
as a consequence, and the patient rapidly falls into a 
condition of premature old age. When this takes 
place as a result of some temporary error of hygiene, 
or as a consequence of diseases which admit of suc- 
cessful treatment, the patient may be restored to health 
by judicious management, but lost youth and elasticity 
of the tissues can never be fully regained. The most 
formidable cases of insomnia are those for which no 
adequate cause can be recognized in the habits, mode 

(56) 



SIGNIFICANCE OF INSOMNIA. 57 

of life, and state of health of the patient. Grave and 
permanent disorder of the brain is then to be feared. 
Such wakefulness is a frequent precursor of acute 
meningitis in children and adults. It frequently ushers 
in the early, insidious, formative stage of tubercular 
meningitis, and of the infective fevers — notably 
typhoid fever. It forms one of the most suspicious 
symptoms among the introductory phenomena of 
insanity ; and during the course of protracted diseases, 
its intrusion is an omen of most unfavorable augury. 
It will, therefore, be found useful to consider with 
some degree of detail the circumstances under which 
insomnia may occur, and the best means of averting 
its onset. 

A severely logical reference to previous doctrines 
regarding the condition of the brain during sleep, has 
led many authors to consider the therapeutical treat- 
ment of insomnia chiefly as a matter of modification of 
the cerebral circulation. Sleep has been supposed to 
depend upon a comparatively bloodless state of the 
brain, and wakefulness upon the contrary state. For 
such theorists the treatment of insomnia consists very 
simply in the use of agents which are supposed to be 
efficacious in reducing the flow of blood through the 
head. Tourniquets, placed upon the carotid arteries, 
occupy a position of great honor in the armamentari- 
um of such people. Kecognizing the fact that changes 
in the force of the circulation accompany and sustain 
every change in the activity of the cerebral cortex, we, 
however, attach the greatest importance to the condi- 
tion of the nervous substance itself. For a clear 
understanding of the proper mode of medication, it is 



58 INSOMNIA. 

important to ascertain whether the cerebral substance 
is in a state of normal activity, or whether it is in a 
state of healthy, but excessive, activity, or whether its 
seeming excitement is merely the result of irritable 
weakness. Since these opposite conditions may de- 
clare themselves during the course of any disease in 
which insomnia may become a troublesome phenome- 
non, it is impossible to make a classification of dis- 
eases upon the basis of these different states of the 
brain. It will, therefore, be found more useful to con- 
sider the subject of sleeplessness as it ordinarily pre- 
sents itself during the clinical progress of the several 
forms of disease. It will, then, appear that the type 
of insomnia is liable to variation with the course of 
each individual malady; and its treatment must vary 
accordingly. 

Before proceeding to a discussion of the therapeu- 
tics of insomnia in connection with particular diseases, 
it will be advantageous to pass briefly in review the 
different remedies which are useful in the treatment of 
wakefulness. These may be divided into two classes: 
Nervous stimulants, and nervous sedatives. Among 
the first may be also reckoned food, heat, baths, and 
counter-irritants. Like all nervous stimulants, they 
promote the complete and harmonious action of all 
parts of the nervous system, favoring that equilibrium 
of the circulation which is most favorable to the devel- 
opment of sleep. The second class of agents com- 
prises all such remedies as act directly upon the 
nervous tissue of the brain, depressing its functional 
activity, and hushing to rest those particular organs 
which, by their undue excitement, serve to keep the 



REMEDIES FOR INSOMNIA. 



59 



remainder in a state of wakefulness. All these sub- 
stances produce decided effects upon the spinal cord 
and the peripheral nerves, but it is their operation 
upon the brain which principally interests us in con- 
nection with insomnia. 



Nervous Stimulants 



Nervous Sedatives. 



Heat. 


Cold. 


Baths. 


Alcohol. 


Massage. 


Paraldehyde. 


Electricity. 


Ether. 


Counter-irritants. 


Chloroform 


Food. 


Chloral. 


Digitalis. 


Butylchloral hydrate. 


Camphor. 


Amyl nitrite, 


Musk. 


Opium and opiates. 


Valerian. 


Bromides. 


Cannabis indica. 


Hops. 


Belladonua. 


Gelsemium. 


Hyoscyamus. 


Conium. 


Stramonium. 




Phosphorus. 




Acids 




Opium. 





NERVOUS STIMULANTS. 

It may at first sight seem to be a contradiction in 
terms when it is asserted that sleep may result from 
the administration of a nervous stimulant. This does 
occur, but only indirectly, and as a consequence of a 
restoration of energy to those portions of the nervous 
system which serve to moderate the activity of the 
organ of the mind — the cortex of the cerebrum. 

Heat, for example, is an undoubted stimulant. 
When added to the body in quantity sufficient to over- 
come chilliness, it tends to equalize the circulation of 



bO INSOMNIA. 

the blood, and produces throughout the body a nerv- 
ous equilibrium that prevents any particular organ 
or member from arousing the others to wakefulness. 

Baths. — The application of heat in the form of a 
warm bath constitutes one of the most admirable means 
of tranquilizing the brain. Children who are restless 
at night are delightfully soothed by a warm bath every 
night and morning. The water should be of an agree- 
able temperature — this is better than any exact figure 
upon the scale of a thermometer — and the bath should 
not last longer than ten minutes. Similar baths exer- 
cise a happy effect upon adult patients who are 
moderately feverish, nervous, and wakeful. If strong 
enough, they may take a full bath at bedtime ; but if 
too feeble to leave the bed, gentle sponging with warm 
water will prove most refreshing, and will usually be 
followed by restful sleep. The well-known derivative 
effects of hot foot baths scarcely need to be more 
than mentioned in this connection. 

Turkish baths form an invaluable adjuvant in the 
treatment of chronic cases of insomnia arising from 
rheumatic, gouty, and dyspeptic disorders of the health. 
The copious perspiration induced by the heated air of 
the hot chamber is depurative, while the cold douche 
and the massage . with which the bath is concluded 
have a powerful effect to stimulate all the functions of 
the body. By this means the brain is enabled to re- 
sume a healthier mode of action, and sleep follows as a 
matter of course. 

Massage. — This constitutes a process of rubbing 
and kneading the body. It has been practiced from 
time immemorial among the oriental races and the 



MASSAGE. 61 

Pacific Islanders as a means of relief from fatigue of 
every kind. Among the Japanese the practice of 
massage is a monopoly in the hands of the blind, who 
are thus enabled to support themselves. Various 
modifications of the oriental method have been intro- 
duced under the names of percussion, shampooing, and 
the Swedish movement cure. They all possess the com- 
mon features of friction applied with the hand to the 
skin, compression of the muscles with the hands, and 
passive movements of the different articulations of the 
limbs and body. For effecting all these processes 
nothing has yet surpassed the Sandwich Island lomi- 
lomi as practised by the court-retainers of the ancient 
chiefs. As a means of relieving fatigue, and of 
removing muscular soreness, after violent exertions 
of every kind, it is far superior to the imitations 
performed by European and American professional 
masseurs and masseuses. Nervous headaches, the 
pains that accompany spinal irritation, and all con- 
ditions of restlessness and wakefulness which depend 
upon exhaustion are relieved by this method. The 
well-known soothing influence of a mother's hand 
stroking the face and forehead of her sleepless child, 
is an example of only one of the effects thus produced 
by the skillful masseur. These salutary results must 
be assigned to the uniform friction of the skin, causing 
the liberation of heat, and modifying the electrical 
conditions of the body. By this, the impressions de- 
rived from the peripheral nerves are reduced to a more 
harmonious series. The circulation of blood and 
lymph is rendered more active in the substance of the 
muscles, and all the processes of nutrition are thus 



62 INSOMNIA. 

stimulated to a degree that restores the equilibrium of 
function throughout the nervous system. Being no 
longer irritated by suffering portions of the body with 
which it is connnected, the brain then yields to the 
effects of its own fatigue, and sleep supervenes. 

Electricity is chiefly useful in those cases where 
it is impossible to discover anything but cerebrasthenia 
as the cause of wakefulness. According to Beard and 
Rockwell, 1 sleep may result from the use of any one of 
the different methods of electrization. The passage of 
a moderate current, either galvanic or faradaic, 
through any portion of the body often produces a 
temporary feeling of sleepiness; but the long con- 
tinued employment of electricity is needful to effect 
those changes in cerebral nutrition which are necessary 
for a permanent cure of insomnia. In cases of sleep- 
lessness caused by worry and overwork, great benefit 
is often experienced from the daily passage of the 
faradaic current from the back of the neck, or from the 
pit of the stomach, to the feet. Static electricity, and 
the electric bath, are also very effective in many cases 
of so-called spinal irritation and insomnia. 

Counter-irritants are substances which are applied 
to the surface of the body for the purpose of com- 
municating to the superficial sensory nerves impulses 
(irritation) which may serve to inhibit the morbid 
functions of distant or central nervous structures. 
Various explanations of this process have been pre- 
sented; notably a most ingenious argument by Dr. T. 
Lauder Brunton a in favor of the theory of inhibition 

1 Medical and Surgical Electricity, 4th ed., p. 413. 
* Nature, March, 1883. 



COUNTER - IRRITANTS. 63 

by interference of vibrations — impulses from the peri- 
phery interfering with vibrations originating in morbid 
conditions of the central nervous organs — very much 
as darkness is produced by the interference of lumi- 
nous undulations, and silence is effected by interfer- 
ence of sonorous waves in the atmosphere. This 
hypothesis is the one that is most conformable to the 
present requirements of science, and is hereby ac- 
cepted as the most satisfactory explanation of the 
action of counter-irritants. 

The drugs in general use for the purpose of counter- 
irritation are ecu it liar ides, capsicum, mustard, thapsia, 
turpentine, aconite, and croton oil. Cups, leeches, and 
certain special applications of electricity, also owe 
much of their virtue to the same power of modifying 
functions at a distance. Under the influence of all these 
agents the molecular vibrations of the brain may be" 
profoundly influenced ; pain may be annulled, and sleep 
be procured. The circulation of the blood is so power- 
fully affected by these measures that their good effects 
are usually attributed to the circulatory changes thus 
produced. But, as in all other modifications of the 
circulation, the nervous tissues and the vascular chan- 
nels must first be reached by influences unconnected 
with the blood itself before its current can be diverted 
from one region to another. The inhibitory action 
upon the nervous organs is the primary effect. The 
diversion of the circulation is a secondary consequence, 
by which, undoubtedly, the degree of nervous change 
can be estimated, and by which the inhibitory effects 
in the brain are intensified and sustained. 

Food. — In a considerable number of cases of insom- 



64 INSOMNIA. 

nia, its cause lies in an irritable weakness of the nerv- 
ous tissues. Exhausted by overwork, or debilitated by 
the loss of blood, or half-starved during the course of 
a long illness like typhoid fever, a condition of wake- 
fulness may be established which will add to the dan- 
gers experienced by the patient. In this state there 
is great restlessness — the sufferer experiences no 
severe pain, but he cannot lie still. This form of 
sleepless agitation is often encountered during the 
later stages of exhausting diseases ; and, if not prop- 
erly treated, it soon leads to a fatal termination. The 
most important remedy for such distress is found in 
food. This must be soluble, diffusible, stimulant, and 
nutritive. Milk, alcohol, eggs, and meat-juice, are the 
typical representatives of such food. Milk should be 
as fresh as possible, and should be slightly salted, in 
•order to hinder the formation of hard curds in the 
stomach. For young children it may be peptonized 
with advantage by gently heating one pint of milk 
with five grains of sodium carbonate and five grains of 
pancreatic extract dissolved in half a pint of water. 
The mixture may be sufficiently warmed by placing it 
in a bottle immersed for half an hour in a jug of hot 
water (Fairchild). By this process the milk is partly 
digested before it is drank, thus relieving the alimen- 
tary canal of a corresponding amount of work. 

Furnished in the form of koumiss, milk is not only 
presented in a digestible form, but the alcohol and the 
acids yielded by its fermentation are powerful aids to 
the process of digestion. Fermented milk forms a con- 
siderable portion of the daily food of the nomad tribes 
of Central Asia, and it is highly esteemed among the 



KOUMISS. 65 

Kussians in the treatment of pulmonary consumption. 
It is useful in all diseases affecting the digestive 
organs, and can often be tolerated, even by very young 
children, when nothing else will remain in the stom- 
ach. Considerable mystery is made of its preparation 
by those who sell it for an enormous price ; but its 
composition is really very simple, and its actual cost is 
within the reach of every one. The following formula 
for its preparation has given great satisfaction to many 
of my patients: 

Dilute five quarts of milk with three quarts of hot 
water. When lukewarm, add half a cupfull of sugar 
of milk (which can be obtained from any wholesale 
druggist), and one bottle of well fermented koumiss 
(or a little yeast). Stir the mixture thoroughly, and 
let it stand in an open jar, at a temperature of about 
72° F., till it begins to curdle. Then stir in half 
a cupfull of pulverized coffee sugar, and cork tightly 
in champagne bottles with the best velvet corks. The 
bottles should be kept quite cool, as fermentation pro- 
ceeds very briskly, and will break the containers if 
left in a warm room. A large ice-box is the best 
receiver during hot weather. The koumiss thus pre- 
pared is ready for use at the end of a week. It may 
be most conveniently drawn from the bottle with a 
champagne tap. The entire cost of the article need 
not exceed seven cents a bottle. 

Sleeplessness caused by chronic dyspepsia will often 
yield to a diet of koumiss, when every other remedy 
has failed. When the stomach is very intolerant, it 
should at first be taken in very small doses, repeated 
as often as every hour. It will soon become possi- 



66 INSOMNIA. 

ble for the same patient to drink two or three quarts 
each day. 

Eggs form one of the most nutritious and easily 
digested articles of diet. They should be taken 
uncooked, beaten up with milk to which a small quan- 
tity of wine or spirits and sugar have been added. A 
glass of eggnogg, thus prepared, is invaluable in 
the insomnia of fevers and other conditions of ex- 
haustion. 

Meat-juice can be procured in numerous forms. 
The various soluble extracts of meat, Valentine's 
liquid extract of beef, Murdoch's liquid food, all repre- 
sent the juice that oozes from rare beef. Its nutritive 
value is not very great, but it possesses considerable 
energy as a stimulant. Meat juice, therefore, occupies 
an important place as an excitant of those functions 
which must be aroused in order to secure the proper 
digestion of other articles of food. It should, therefore, 
be administered in connection with them. As the 
ordinary meat extracts are frequently very unpalatable, 
they may be administered in fresh broth or soup, to 
which they give body and energy without unpleasantly 
affecting their savory taste. 

Neurasthenic patients, whose insomnia results from 
physical exhaustion, should never retire at night with- 
out taking some form of light and easily digested food. 
A simple slice of bread, or a piece of plain sponge- 
cake, with a glass of koumiss, forms an excellent model 
for such a meal. 

Digitalis is only indirectly useful as an hypnotic. 
In cases of cardiac disease, with enf eeblement of the 
heart, dyspnoea, dropsy, and sleeplessness, digitalis is 



DIGITALIS — CAMPHOR — MUSK. 67 

often of the greatest service. It has also been highly 
recommended in delirium tremens. Administered in 
the form of an infusion, it has been given in doses of 
a tablespoonf ul, every four hours, with apparently good 
effect. Its use is indicated in cases characterized by 
weakness of the heart, with a rapid and feeble pulse. 
Under its influence the state of the circulation im- 
proves, delirium ceases, and sleep occurs. 

Camphor. — This substance is not an hypnotic, but 
it forms a valuable addition to various hypnotic com- 
pounds. It is a cerebral stimulant, and aids in the 
establishment of that nervous tranquility which favors 
the incidence of sleep. It may, therefore, be advan- 
tageously associated with opiates in the restlessness 
and insomnia of exhaustion. Tully's Powder, a valua- 
ble substitute for Dover's Powder, contains camphor. 
This renders it preferable to the ordinary opiates in 
typhoid fever, and in other exhausting diseases. 

Musk, the dried secretion of the preputial follicles 
of the musk-deer, is a substance which, on account of 
its high price, is rarely used as an hypnotic. Given 
in doses of ten grains, every two or three hours, it is 
exceedingly valuable (Stille and Maisch) for the relief 
of " all those nervous phenomena which are represented 
by the term ataxia, and among them subsultus ten- 
dinum, mild muttering delirium, floccitation, muscle 
volitantes, and hiccough, with a small, frequent, tremu- 
lous or irregular pulse, without coma and without col- 
lapse. Under these circumstances musk tends to pro- 
duce refreshing sleep, while it calms muscular spasm 
and favors perspiration, while the pulse grows fuller, 
more regular, and less frequent. ... In propor- 



68 INSOMNIA. 

tion as ataxic prevail over adynamic phenomena is 
musk advantageous." Such conditions are chiefly- 
encountered in typhus, typhoid fever, the eruptive 
fevers, and pneumonia. Musk is very efficacious for 
the relief of "wakefulness resulting from combined 
mental and bodily fatigue — such cases, in fact, as are 
benefitted by valerian, camphor, asafetida, and am- 
monia." 

Valerian and its different preparations form a typi- 
cal class of agents which indirectly favor sleep by their 
gently stimulant effect upon the brain. They are all 
useful in quieting that form of hysterical excitement 
to which women are liable during the " change of life." 
That form of restlessness, usually resulting from 
fatigue, in which the patient feels as if she cannot sit 
still, is often relieved very promptly by the valerianate 
of ammonia. Wakefulness caused by neuralgic pains, 
or by exhaustion, often yields readily to scruple doses 
of valerianate of zinc or ammonia. The elixir of the 
valerianate of ammonia is a very elegant preparation 
of the drug. 

Cannabis Indica. — A cerebral stimulant which pro- 
duces, at first, an agreeable exaltation of the mental 
faculties. This is followed by a condition of delirium, 
succeeded in its turn by sleep. It is, therefore, im- 
possible to use the drug for merely hypnotic purposes ; 
but it is a useful adjuvant, in small doses, to other 
hypnotic remedies. Given in doses of -| — 1 grain, 
it may be advantageously associated with opiates, or 
with hyoscyamus or belladonna in cases which do not 
easily tolerate the preparations of opium. The tannate 
of cannabin, given in doses varying from five to ten 



BELLADONNA. 69 

grains, has been recommended as an hypnotic; but, 
like the extract from which it is derived, its effects are 
rather uncertain. The pure alkaloid, cannabin, has 
been recently introduced as a soporific, in doses of 
three-quarters of a grain to a grain and a half. Ac- 
cording to Stille" and Maisch, the wakefulness caused 
by the itching of eczema may be relieved by the use of 
cannabis indica. The uneasy sleep attendant upon 
ungratified sexual appetite may also be relieved in the 
same way, since the drug is decidedly anti-aphrodisiac. 
Belladonna is not directly hypnotic, unless given 
in poisonous doses, but its medicinal operation tends 
to overcome certain conditions that hinder sleep. By 
its anti-spasmodic effects it relieves many forms of 
spasm which would otherwise interfere with sleep. 
Spasmodic asthma furnishes an example of such an 
affection. This may be relieved by the hypodermic 
injection of atropine. Whooping cough is another dis- 
ease which may be largely controlled by the internal 
administration of the drug, especially by inhalation of 
a spray that has been medicated with belladonna. 
Neuralgia, especially the form that involves the head, 
face, and intercostal nerves, is greatly mitigated by the 
use of belladonna, or its alkaloid, atropia. Its asso- 
ciation with opiates seems to increase their hypnotic 
effect, while at the same time neutralizing their dis- 
agreeable action. According to Curci, 1 it opposes the 
tendency of opiates to cause cerebral hyperemia. For 
this reason it is generally advisable to combine sul- 
phate of atropia with sulphate of morphia for hypo- 
dermic use. Of the former 1-100 — 1-80 grain may 

1 Lo Sperimentale ; April, 1884. 



70 



INSOMNIA. 



be used with J grain of the latter. Certain patients 
are exceedingly intolerant of belladonna and its de- 
rivatives, a fact that must be kept in mind, especially 
when using the alkaloid, atropia. Fatal consequences 
are very rare, but uncomfortable dryness of the throat, 
dilatation of the pupils, and some degree of delirium 
are not uncommon. At the same time it must be ad- 
mitted that in many instances relief from suffering is 
not obtained until these physiological effects of the 
drug have been manifested. 

Hyoscyamus. — As might be inferred from their 
close botanical relationship, hyoscyamus and bella- 
donna present many points of similarity. Their alka- 
loids are almost identical in chemical and physiologi- 
cal properties. The extract of belladonna is consider- 
ably stronger than the extract of hyoscyamus. Like 
other solanaceous plants, this is powerfully narcotic 
and anodyne. Sleep is produced only by the use of 
the drug in large doses, which also tend to excite de- 
lirium, sometimes even reaching to the height of 
maniacal fury. Children tolerate hyoscyamus in doses 
proportionally larger than can be taken by adults. 
By many physicians it is considered the hypnotic par 
excellence for children. In the various forms of insanity 
the tranquilizing influence of hyoscyamus is highly 
esteemed. The derivative preparations, hyoscyamine 
and hyoscyamia, are preferable for use in this class of 
cases. The first may be given in doses of 1-16 — 1 
grain; the latter is much more powerful, and should 
be given in doses not exceeding 1-100 grain until the 
degree of its tolerance has been ascertained. 

Stramonium. — This is another of the solanaceous 



STRAMONIUM — PHOSPHORUS — ACIDS. 71 

plants, possessing many qualities like those found in 
belladonna. It is not directly hypnotic. Poisonous 
doses produce delirium and persistent insomnia. But 
its anti-spasmodic effect upon the paroxysm of nervous 
asthma renders it indirectly hypnotic in that affection. 
For the relief of bronchial spasm the smoke of the 
dried leaves should be inhaled in considerable quantity. 
It may be smoked in a pipe ; or, mixed with saltpetre, 
it may be made to smoulder upon a tin plate, while 
the smoke is drawn by inspiration into the lungs. 
Various kinds of medicated pastiles have been pre- 
pared, to effect a similar result by furnishing the drug 
in a convenient form for use. Tobacco and lobelia 
operate in a very similar manner upon all spasmodic 
affections of the respiratory passages ; but their energy 
is almost too great for the comfort of the patient. 

Phosphorus. — Bartholow has recommended this 
drug in " cases of wakefulness dependent on cerebral 
anaemia and exhaustion," and in " the wakefulness of 
the aged, accompanied with muscular cramps, feeble- 
ness of memory, giddiness, and trembling of the 
voluntary muscles on exertion. 1 ' In minute doses, it 
is true that phosphorus acts as an irritant of nervous 
tissue. It promotes destructive changes in the tissues 
of the body, and thus produces a temporary excitement 
which may favor the processes of nutrition. In- 
directly, it may thus prove beneficial in many cases of 
cerebral exhaustion; but as a direct hypnotic it will be 
found of very little service. It should be given in 
doses of 1-100 grain every four hours. 

Acids. — In those forms of sleeplessness which are 
dependent upon disordered conditions of the digestive 



72 INSOMNIA. 

apparatus, acids are often useful. Their topical effects 
upon the mucous membrane of the stomach are stimu- 
lant and alterative; hence they are useful in atonic 
dyspepsia, where there is deficient secretion of the 
gastric juice. In such cases hydrochloric acid and 
lactic acid are useful. The first should be given, in 
doses of five drops diluted with half a pint of water, 
after each meal. Lactic acid may be given in doses of 
one or two teaspoonfuls, similarly diluted. It has been 
asserted, on theoretical grounds, that lactic acid and 
the lactate of sodium are directly hypnotic, but its ex- 
perimental use has never given satisfactory results. 
Phosphoric acid has been used in the same way, with 
very similar effects. An impure solution of phos- 
phoric acid, known as Horsford's Acid Phosphate, has 
been extensively used for its supposed hypnotic prop- 
erties. It assists digestion, stimulates the kidneys, 
and by its general diffusion promotes molecular activity 
throughout the body. It is thus indirectly beneficial 
in cases of insomnia. No small part of the benefits 
thus obtained must, however, be ascribed to the water 
with which these acids are diluted. When the liver 
becomes sluggish in its action, nitric acid, in doses of 
five drops diluted with half a pint of water, may be 
taken every four hours with great advantage. Thus 
used, the mineral acids may often yield invaluable ser- 
vice in the treatment of insomnia occasioned by cachectic 
conditions of the body — notably such as are produced 
by malaria, oxaluria, and the so-called phosphatic and 
rheumatic diatheses. 



NERVOUS SEDATIVES — COLD. 73 

NERVOUS SEDATIVES. 

The remedies thus far considered are but indirectly 
hypnotic in their effects, though exceedingly valuable 
as agents for the production of conditions favorable to 
sleep. We may now pass to the consideration of a 
class of remedies which operate more directly upon 
the brain to depress its energy. They are, therefore, 
called nervous sedatives, and they include the majority 
of narcotic substances. 

Cold. — The operation of cold upon the body has 
already been sufficiently considered. It only remains 
to note the effects of cold applied through the agency 
of baths and local refrigerants. A full account of the 
theory and practice of hydrotherapeutics can be found 
in the second volume of Von Ziemssen's Handbuch der 
Allgemeinen Therapie. The English reader will find 
the subject treated at sufficient length in Ringer's 
Handbook of Therapeutics. 

According to Ringer, the sitz-bath, taken at a tem- 
perature between 60° and 80° F., is very useful to 
soothe " an irritable restless state of the nervous sys- 
tem." It should be employed once or twice a day, 
from five to thirty minutes at a time. Among other 
beneficial consequences is the promotion of quiet sleep. 

For the relief of the pungent heat and restlessness 
which add so much to the danger of the specific fevers 
cold baths have been highly recommended. These 
have been employed with great energy in many of the 
German hospitals; and often with great benefit to the 
patient. The preferable method is the one advised by 
Von Ziemssen and Immerman. The patient is placed 



74 INSOMNIA. 

in a tub of water at 95° F. This is very gradually 
cooled down, in the course of half an hour, to 60° F. 
The bath should be repeated from three to five times a 
day. according to the temperature of the patient. By 
this method of treatment the patient is made more 
comfortable ; he becomes less restless or delirious, and 
secures a larger amount of refreshing sleep. 

The difficulty of administering such a laborious 
course of baths outside of a well equipped hospital 
renders its adoption almost impossible in private prac- 
tice. Here the physician must rely upon assiduous 
sponging with water of an agreeable temperature. In 
severe cases, such as measles before the appearance of 
the eruption, scarlet fever during the period of heat 
and agitation, and typhoid fever during the correspond- 
ing stage, great benefit will be derived from the cold 
wet sheet. In order to humor the prejudices of the 
laity, this should be wrung out of warm water, and 
applied with sufficient deliberation to insure its con- 
siderable loss of heat. A blanket should first be 
spread upon an empty bed; the wet sheet should be 
spread over the blanket. The patient must be placed 
naked upon the sheet, which should then be drawn 
around the entire body, and the blanket may be folded 
around the whole package. Children generally insist 
upon leaving their arms uncovered. This may be 
alloAved with safety in many cases, but generally a wet 
napkin should cover the upper part of the chest and 
the neck which cannot be reached with the sheet when 
the arms are exposed. After remaining from half an 
hour to two hours in the pack, the patient becomes 
comparatively cool and quiet, and the eruption, if de- 



COLD BATHS — ANESTHETICS. 75 

layed, begins to appear. Sleep often occurs as an 
immediate consequence of the relief thus obtained. 

Similar good results may be secured by the use of 
cold affusion in cases of high temperature and great 
restlessness. I well remember a little boy, about eight 
years old, whom I once found rolling and tossing and 
burning up with scarlet fever. Calling for an empty 
wash-tub, I had him stripped and placed upright in 
the tub. I then began to pour cold water over him 
from a large pitcher. Scaicely had the water touched 
his skin, before he seized the pitcher, and began to 
drink from it. He was permitted to completely slake 
his thirst, and then the affusion was resumed. After 
four or five gallons of water had been thus poured over 
him, he was wiped dry, and was returned to his bed, 
where he immediately turned upon his side, and fell 
into a peaceful sleep. A few more affusions relieved 
him from danger, and he made a rapid recovery. 
Were people less afraid of such measures, a consider- 
able portion of the danger in fevers might be obviated. 
Great discretion, however, is necessary in the applica- 
tion of such treatment, for Ringer states that he has 
" seen a child, suffering from scarlet fever, killed by 
an over-energetic employment of cold." The tempera- 
ture of the patient should be carefully noted, and its 
reduction below the normal standard should never 
be permitted. 

Ancesthetics. — All anaesthetics are hypnotics. In 
other words, they possess the power to abolish con- 
sciousness, and thus to produce a condition resembling 
sleep. This is effected by the direct action of the an- 
aesthetic substance upon the cellular structure of the 



76 INSOMNIA. 

brain, reducing the molecular movements of the living 
protoplasm below the degree requisite for the ex- 
citement of consciousness. This sedative effect is 
preceded by a brief period of cerebral exaltation, occa- 
sioned by the disturbances caused by the first intro- 
duction of the drug into the current of the circulation. ' 
It is with the subsequent hypnotic effect only that we 
are now concerned. Of the numerous anaesthetic sub- 
stances that have been discovered, but few compara- 
tively have been found sufficiently manageable and 
safe for general use. These are alcohol, paraldehyde, 
ether, compound spirits of ether, chloroform, chloral, 
butylic chloral, and amylic nitrite. 

Alcohol. — The hypnotic effect of alcoholic drinks is 
very decided, though not speedily manifested unless 
the beverage be taken in considerable quantity. Dis- 
tilled liquors produce the effect of alcohol in its sim- 
plest form; wines, containing various forms of ether, 
arouse the nervous system more thoroughly and agree- 
ably than the pure alcoholic stimulants. Beer and 
porter are rendered more powerfully narcotic by the 
active principle of hops which they contain. The 
nutritive substances held in solution by these last ren- 
der them peculiarly appropriate in cases that require 
nourishment as well as rest. The considerable quan- 
tity in which they must be taken, renders them incon- 
venient for use in cases of severe illness. Wines and 
distilled liquors are then most available. 

Alcohol is principally useful as an hypnotic when 
wakefulness is associated with great bodily exhaustion, 

1 Artificial Ancesthesia and Ancesthetics, pp. 20-28. William Wood 
& Co., New York, 1881. 



ALCOHOL. 77 

such as may be experienced in advanced stages of the 
infective fevers. In such cases the heart is weak- 
ened, the pulse is rapid and feeble, the muscular appa- 
ratus is wasted and irritable, the blood is diminished 
in volume and tends to accumulate in the venous 
channels. Under such conditions the patient is usu- 
ally delirious, tossing from side to side, and quite de- 
prived of sleep. An ounce of brandy, repeated at 
intervals varying according to the severity of the 
symptoms, and given with milk and egg, in the famil- 
iar form of eggnogg, will often quiet this harassing 
restlessness, and will procure refreshing sleep. The 
temperature of the patient will then decline; the 
tongue will grow moist; and the delirium will dimin- 
ish or subside altogether. Sometimes, however, a con- 
trary result is observed. Alcohol should then be 
administered with a sparing hand, and it will proba- 
bly be necessary to resort to the bromides or other 
cerebral sedatives. 

The great exhaustion which is manifested in delir- 
ium tremens sometimes requires the use of alcohol to 
support the patient, so that sleep may be procured. It 
is in such cases advisable to combine the administra- 
tion of capsicum with that of alcohol. According to 
Einger, capsicum should be given for this purpose in 
scruple doses, made, into a bolus with honey, and 
repeated every three hours. 

Wakefulness caused by neuralgic pains is speedily 
relieved by full doses of alcohol. The various species 
of abdominal and pelvic neuralgia may thus be tem- 
porarily suspended. In like manner the " rheumatic " 
pains which afflict the overworked and underfed poor 



78 INSOMNIA. 

may be calmed for a season sufficient to procure sleep. 
The obvious dangers attendant upon such medication, 
however, need no comment. 

Old people not unfrequently suffer with a form of 
insomnia that is associated with feeble and painful 
digestion. This is probably caused by insufficient 
gastro-intestinal secretion. The use of wine contain- 
ing a large proportion of compound ethers gives relief 
through the improvement in digestion consequent upon 
the stimulant effect of small doses of alcohol and 
ether. Under their influence the digestive fluids are 
more abundantly secreted, and all the bodily functions 
are quickened. Such good results, however, only fol- 
low the moderate use of the stimulant. It must never 
be taken in quantity sufficient to affect the intellectual 
functions, or to disturb any of the normal processes of 
life. The best results, so far as digestion is concerned, 
are obtained by the use of wine with the meals ; but a 
night-cap, in the form of hot toddy, is sometimes nec- 
essary in addition. This is especially useful if there 
be any form of irritative cough or local excitement, 
such as the aged sometimes experience. 

The insomnia that attends excessive fatigue may be 
very quickly relieved by the use of food and alcohol. For 
this purpose any form of alcoholic drink will be found 
useful. The quantity administered should only be 
sufficient to produce a uniform and general vascular 
relaxation. By this means the circulation is equalized 
throughout the body, and the brain passes into a state 
of tranquil sleep. Any excess in the use of alcohol 
under such conditions will be followed by headache 
and discomfort on awaking. In all cases the intoxi- 



PARALDEHYDE. 79 

eating dose of alcohol must be avoided, if its truly 
hypnotic effect be desired. 

Paraldehyde. — This is a derivative from ethyl alco- 
hol. It is, when pure, a colorless liquid, with an 
agreeable odor, somewhat like that of ether. It is sol- 
uble in the proportion of one part in eight or nine of 
water. It may be used internally in doses varying 
from forty-five to one hundred and sixty grains. A 
watery solution, containing one part to ten, has been 
recommended for internal administration. It may also 
be given in milk or in beer. M. Yvon 1 recommends the 
following formula: 

Paraldehyde, Gr. 20.0 

Spirit, - - - -' 100.0 

Syr. Simpl., - - - 75.0 

Tr. Vanillse, - 5.0 

An ounce of this mixture contains forty-five grains 
of paraldehyde. When taken it should be still further 
diluted with sweetened water, or with beer, to obviate, 
as far as possible, the disagreeable taste of the drug. 
Sleep follows after the lapse of about half an hour, and 
continues from five to seven hours. The physiological 
action of the medicine is very similar to that of chlo- 
ral hydrate, and its use is indicated in the same class 
of cases to which that drug is appropriate. By many 
it is considered the preferable hypnotic. It has found 
considerable employment in the insane asylums of 
Europe, and in other institutions where disagreeable 
medication is no obstacle to experiment. In private 

l Bull.gM. de Thcrap., 1884, 2° Livr. 



80 INSOMNIA. 

practice the peculiar taste and smell of the article, and 
its pungent effect upon the mucous membranes of the 
alimentary canal, render its exhibition more difficult. 
But the weight of testimony is in its favor as an hyp- 
notic in all cases, uncomplicated with disease of the 
stomach, in which insomnia is not dependent upon 
pain, and is associated with cerebral hyperemia. Its 
administration is followed by no unpleasant conse- 
quences. Among the insane it is particularly recom- 
mended during periods of excitement and wakefulness. 
It has been employed with great satisfaction 1 in cases 
of insomnia during the course of such varied diseases 
as emphysema, bronchitis, phthisis, nervous and spinal 
disorders, diseases of the heart, jaundice, chronic 
rheumatism, and insomnia from other unrecognized 
causes. Undoubtedly, with greater skill in its purifi- 
cation and exhibition, it will become one of the most 
valuable of hypnotic remedies. Almost useless for the 
relief of pain, it is indicated in cases of uncomplicated 
insomnia. Having very little power, in moderate 
doses, to depress the action of the heart, it is prefera- 
ble to chloral hydrate in cardiac diseases and debility. 
Sleep procured with doses of fifteen to sixty grains is 
calm and refreshing, and is not followed by any disa- 
greeable consequence. A certain degree of tolerance 
is gradually established, so that larger doses may be- 
come necessary. It has been given in quantities 
amounting to three drachms; but, if large doses be 
given before the development of tolerance, the patient 
will experience headache, uneasiness, nausea, and vom- 
iting, after waking from the sleep thus induced. An- 

1 Centralblatt fur klin. med., 1884. Nr. 12. 



ETHER — CHLOROFORM. 81 

other advantage possessed by paraldehyde consists in the 
absence of the period of excitement produced by chlo- 
ral before the advent of sleep. It is an hypnotic, with- 
out narcotic properties, limiting its effects chiefly to 
the brain, and leaving the spinal cord in a condition 
nearly like that of natural sleep. 

Ether, though possessed of the greatest value as an 
agent for the production of artificial anaesthesia, is 
rarely used as a mere hypnotic. Diluted with alcohol 
and ethereal oil, it forms the Compound Spirit of 
Ether, or Hoff mantis Anodyne. In this form it is 
well adapted for internal administration. It is thus 
very serviceable in the treatment of those forms of in- 
somnia associated with nervous irritability and hysteria. 
For the relief of wakefulness dependent upon a languid 
circulation, with cold feet and flatulence, the anodyne 
may be given in half -drachm doses well diluted with 
ice water, and repeated every fifteen minutes till relief 
is obtained. Nearly all forms of painful or spasmodic 
disturbance unattended by fever may be thus relieved. 
For this reason it is particularly useful in the treat- 
ment of uterine colic and in sleeplessness after child- 
birth, when opiates cannot be tolerated, or are contra- 
indicated on account of their tendency to excite the 
brain. 

Chloroform, like ether, is an agent too powerful 
and too evanescent for use as a simple hypnotic. But 
for the relief of intense suffering caused by nervous 
irritation and spasm it is without any superior. In 
certain minor affections of a spasmodic character it, 
therefore, forms a valuable adjuvant to other remedies. 
Diluted with alcohol it forms the spirit of chloroform, 
6 



82 INSOMNIA. 

a remedy which is useful in all cases for which the com- 
pound spirit of ether is usually prescribed. In this form 
it is an excellent addition to various mixtures designed 
for the relief of spasmodic coughs by which sleep is 
disturbed. Ringer recommends it in the treatment of 
the irritative cough so characteristic of fibroid phthisis. 
It should also be used in cases of spasmodic asthma. 
The asthmatic paroxysm may frequently be arrested 
by inhalations of the vapor of chloroform or ether; 
but, unfortunately, the lungs soon become tolerant of 
these agents, and they then cease to afford relief. The 
valuable mixture known by the name chlorodyne owes 
a considerable portion of its efficacy to the presence of 
chloroform as one of its ingredients. 

Chloral. — Until the recent introduction of paralde- 
hyde, chloral hydrate has for many years held the first 
rank as an hypnotic. It is particularly useful in wake- 
fulness occasioned by exhaustion of the nervous cen- 
tres. The conclusions of all experienced observers 
have been most concisely stated as follows: ' "Chloral 
appears to be indicated when sleeplessness is depend- 
ent upon a vascularity due to exhaustion rather than 
to primary excitement of the brain; thus it has been 
found useful when loss of sleep follows severe and 
prolonged mental application or excitement of feeling, 
or accompanies the general debility following acute 
diseases attended with delirium or severe pain, or is 
associated with acute mania, especially of the puerperal 
form. The somewhat analogous condition which exists 
in delirium tremens is very amenable to this medicine, 
especially in the forming stage of the affection known 

1 The National Dispensatory , 18S4, p. 433. 



CHLORAL — BUTYLCHLORAL. »3 

as 'the horrors,' and which so frequently follows sur- 
gical injuries in drunkards ; it is useful *riso when great 
nervous excitement and restlessness are associated with 
extravagant phantasms. Nevertheless, its depressing 
effects are to be guarded against in this affection as in 
the different forms of insanity." This caution is 
directed against the frequent and repeated employment 
of the article in chronic cases, on account of the vaso- 
motor paralysis and general cachexia thus induced. It 
is now claimed that many of these consequences may 
be avoided by the substitution of paraldehyde in the 
place of chloral, but it has been shown ' that similar 
effects may follow the long continued use of this sub- 
stitute. 

Chloral is usually administered by the mouth in 
doses, for adults, of twenty to thirty grains, dissolved 
in sweetened peppermint water. If the first dose does 
not procure sleep, it may be followed at the expiration 
of an hour by a second dose of twenty grains. This 
seldom fails to induce refreshing sleep. When the 
medicine cannot be tolerated by the stomach it may be 
given by enema in milk. For this purpose a drachm 
of chloral should be suspended with the white of an 
egg in half a teacupful of milk. 

Butylchloral hydrate. — This substance has been 
recommended as a substitute for chloral hydrate, in 
cases of cardiac weakness, on account of its being less 
powerful to depress the action of the heart. It is 
principally useful for the relief of facial neuralgia and 
hemicrania. As an hypnotic it is seldom used. For 
this purpose it may be given in a solution like that of 

1 Deutsche Med. woc/iensc/ir.,i8$3, Nr. 49. 



84 INSOMNIA. 

chloral hydrate. For a simple anodyne effect the 
medicine may be given in five-grain doses, repeated 
every half hour or hour. As a means of procuring 
sleep it may be given in doses ranging from fifteen to 
forty-five grains. Liebreich has given the medicine 
in drachm doses, and recommended it as an hypnotic 
superior to chloral hydrate. It is useful in the sleep- 
lessness of headaches, neuralgia, dysmenorrhea, and 
chronic phthisis. 

Amyl nitrite. — This drug has been recommended 
for the relief of insomnia resulting from the opium 
habit. Einger considers it useful in the flushes of 
heat and other forms of discomfort which sometimes 
interfere with the sleep of women during the change 
of life. It should be inhaled in the form of vapor, 
from a handkerchief upon which five drops have been 
poured. The quantity will need to be gradually in- 
creased, as the system becomes tolerant of its effects. 
The stimulant effect of the medicine renders its use in 
this manner probably less dangerous than the similar 
employment of chloroform. Unlike the other anaes- 
thetics above mentioned, it causes a hypersemic condi- 
tion of the brain, and is, for this reason, a useful 
hypnotic in cases of aortic obstruction with an insuf- 
ficient cerebral circulation and consequent wakeful- 
ness. 

Opium and opiates. — There seems to be no agree- 
ment among experimental physiologists regarding the 
manner in which opium produces its effects upon the 
body. By some it is ranked as a stimulant ; by others 
it is considered a sedative. These different opinions 
are probably due on the one hand to differences in the 



OPIUM AND OPIATES. 85 

dose and strength of the opiates employed, and on the 
other to idiosyncrasies on the part of the individuals 
subjected to experiment. The soporific effect of the 
drug appears to result from its direct action upon the 
substance of the brain. Under its influence the blood 
tends to accumulate in the veins, and loses its bright 
arterial hue. Small doses are said to contract the 
capillaries of the body, while they are dilated by exces- 
sive doses of the drug. From this it may be inferred 
that opium acts, like many other narcotics, as an irri- 
tant of the tissues when given in minute quantity, and 
as a paralyzing agent when a certain relative amount 
is exceeded. The experiments of Curci l indicate that 
under the influence of irritating doses of morphia the 
brain becomes hyperemia 

Opium is a remarkably complex substance, no less 
than nineteen different alkaloids having been separated 
from it. Of these, however, only one has stood the 
test of therapeutical experiment — morphia. Several 
other constituent alkaloids, notably codeia, have been 
lauded as hypnotics, but they are, at their best, far 
inferior to morphia, and may well be omitted from the 
list of sleep producers. But, though the soporific 
properties of opium are chiefly due to the morphia 
which it contains, there are certain points of difference 
between the action of the two medicines that often 
render a choice desirable. According to Stille and 
Maisch, 2 morphia does not stimulate circulation and 
the nervous system as much as opium, and its narcotic 
effects are less decided and speedy, though its after 

1 Lo Sperimentale, April, 1884. 

2 The National Dispensatory, 1884, p. 993. 



86 INSOMNIA. 

effects are more enduring. Opium increases the bodily 
temperature and sense of heat; morphia produces the 
last effect, but diminishes the temperature. Opium at 
first increases the frequency of the pulse, while 
morphia diminishes it. Opium is of the two the less 
liable to excite nausea and vomiting; hence the supe- 
riority of the tinctures and aqueous solutions of opium 
when nausea is specially feared. 

Of all the remedies for the relief of pain opiates 
are the most effectual. Before the introduction of the 
alcoholic hypnotics and the bromides, they constituted 
the principal agents in the treatment of insomnia. 
Even at the present time they are indispensable for 
the relief of all forms of sleeplessness dependent upon 
pain. A combination of chloral hydrate, sodium 
bromide, and morphine forms one of the most gen- 
erally useful hypnotic compounds ever employed. 

Under ordinary circumstances morphia is the 
preferable opiate for the relief of insomnia. The sul- 
phate is most frequently employed, but the acetate and 
the tartrate have been recommended on account of their 
supposed superiority in the formation of solutions that 
are unirritating and permanent in their character. The 
hypodermic method of administration forms the most 
prompt and efficient mode of procuring the effect of 
the medicine. It should be given in a dose of quarter 
of a grain about an hour before the time when sleep is 
desired. For some patients a longer time is necessary 
to develop its hypnotic effect. To children the 
hypnotic dose must sometimes be given at three o'clock 
in the afternoon in order to induce sleep at nine o'clock 
in the evening. As the effect of opiates is highly 



OPIUM AND OPIATES. 87 

stimulant to the sweat-glands, and is often productive 
of nausea, it is advisable to associate atropine with 
morphine when thus given. For an adult the hun- 
dredth of a grain of atropine may be given with every 
quarter of a grain of morphine. The soothing and 
agreeable effects of morphia are thus intensified, while 
its disagreeable tendencies are reduced to a minimum. 
The injection should be made into the loose areolar 
tissue between the skin and the muscles. Its location 
is a matter of little importance so far as the relief of 
pain is concerned; but the neighborhood of the blood 
vessels should be avoided, since alarming symptoms 
have been observed after injection into a vein. The 
outer aspect of the arm near the insertion of the deltoid 
muscle is a favorite site for puncture. If, for any 
reason, the hypodermic use of morphia cannot be 
employed, it may be introduced into the rectum either 
in solution or in a suppository. The bowel should first 
be washed out with an enema of warm water ; the opiate 
may then be introduced. The dose thus exhibited 
need scarcely exceed that usually given by the mouth; 
but, if the rectum is not previously cleansed, a double, 
or even triple, dose may be required. 

As an hypnotic morphia is chiefly useful in phthisis, 
in cardiac dyspnoea, in diseases of the stomach which 
cause insomnia, in fevers with prostration and delirium, 
in delirium tremens, in mania, and in the majority of 
painful or spasmodic diseases. If the patient be 
violently excited, the opiate should be combined with 
small doses of tartar emetic, ipecac, or tincture of 
aconite. But in the chronic diseases it is desirable to 
avoid its continuous administration, not only on account 



88 INSOMNIA. 

of the risk of creating the opium habit, but also by- 
reason of the injurious effects of the drug upon diges- 
tion and nutrition. 

Codeine is a mild hypnotic which may be used in 
doses about twice as large as those of morphine. It is 
expensive and not very efficient, but may be sometimes 
prescribed with advantage when moral considerations 
render the use of ordinary opiates inexpedient. 

Laciucarium may be classed with the weaker 
opiates. It possesses very little value. . Its fluid ex- 
tract is sometimes prescribed at night to allay the 
cough of pulmonary consumption, so as to favor sleep. 

Bromides. — According to Mitchell, Echeverria, and 
Bartholow, the soporific energy of the bromides may 
be ranked as follows: Lithium bromide first, sodium 
bromide second, potassium bromide third. Hammond 
praises calcium bromide. Hydrobromic acid is also 
employed as an hypnotic in certain cases. As a clinical 
fact the bromides of sodium and potassium are most 
frequently employed for the relief of insomnia. Of 
these the second is most useful when sleeplessness is 
associated with the phenomena of irritability; the first 
is less energetic in its effects upon the motor structures 
of the body. 

The bromides act upon the protoplasmic constitu- 
ents of the body, directly inhibiting their functional 
energy. Upon the spinal cord they act to diminish 
reflex excitability. Under their influence the recep- 
tivity and functional capacity of the brain is reduced. 
The minute blood vessels contract in consequence of 
the inactivity of the tissues which they supply. A 
lethargic sleep is thus induced. 



BROMIDES. 89 

For the reasons above stated the bromides find their 
greatest opportunity for usefulness in cases of over- 
excitement and exhaustion of the brain. When the 
cortical cells have degenerated into a condition of 
irritable weakness, characterized by inordinate insta- 
bility of substance, the bromides serve to steady the 
fabric by retarding those movements of disintegration 
which produce morbid wakefulness. Almost useless in 
cases marked by active congestion of the brain, they 
are invaluable in the insomnia produced by excessive 
mental exertion, care, emotion, worry and fatigue. 
The wakefulness of hysteria, of asthenic mania, and of 
sexual excitement, is often greatly relieved by the ad- 
ministration of the bromides. The prodromic stage of 
delirium tremens, before any violent outbreak, and the 
wakefulness of convalescence from acute diseases are 
often cured by their use. Mental disturbances and 
morbid impulses associated with pregnancy or the 
puerperal state may be dispelled in the same way. 
The screaming fits of night terrors in children are 
benefitted by these medicines. They seem to increase 
the efficacy of chloral, chloroform, ether, cannabis 
indica, hyoscyamus, belladonna, and the opiates. 

The hypnotic dose of hydrobromic acid is twenty- 
five grains, largely diluted with sweetened water. For 
this reason, and for its disagreeable taste, it is not an 
eligible preparation. Lithium and calcium bromides 
may be given in scruple doses every hour or two till 
sleep is produced. Sodium and potassium bromides 
should be given in doses of thirty or forty grains every 
two hours. 

It is sometimes remarked that instead of favoring 



90 INSOMNIA. 

sleep the bromides only increase wakefulness. In such 
cases opiates and alcoholic stimulants are usually in- 
dicated. 

Hops. — The principal sedative constituent of this 
plant is the yellow glandular powder found in the 
strobiles ; this is called lupulin. Hops do not exhibit 
any directly narcotic property; but they serve to allay 
nervous excitement, and thus favor the occurrence of 
sleep. They are principally useful in cases of irrita- 
bility of the bladder and sexual organs; in dyspepsia 
caused by irritable weakness of the stomach; and in 
the exhaustion of delirium tremens. The infusion is 
the best preparation for internal use. It may be taken 
in doses of one or two ounces, as required. Lupulin 
may be given in doses of ten grains or more. Its fluid 
extract is prescribed, fifteen or twenty minims in sweet- 
ened water whenever needed. The best method, how- 
ever, of securing the beneficial effects of the medicine 
consists in the administration of a mild beer that is rich 
in hops. A glass at bedtime often forms a sufficient 
hypnotic. 

Gelsemium is a very powerful agent for depressing 
the pulse and the functional activity of the spinal cord. 
It thus favors the induction of sleep in cases attended 
with violent excitement, such as may be witnessed in 
acute mania. It has been employed in the treatment 
of delirium tremens ; but the poisonous qualities of the 
plant render its use somewhat dangerous. The toxic 
effects are sometimes developed quite suddenly, and in 
a manner very alarming to the laity. For these 
reasons it is not to be recommended as a soporific, 



CONIUM. 91 

unless the patient can be continually under the eye of 
the physician or of an intelligent nurse. 

Conium has been found useful in the insomnia of 
mania, not through any narcotic property of its own, 
but by reason of its sedative effects upon the spinal 
cord and nerves. Under its influence the excitement 
of the patient is so far reduced that other hypnotic 
remedies can produce their effect. For this purpose 
Squibb 1 s fluid extract, in doses of about one-third of a 
drachm, or one-sixtieth of a grain of coniine, may be 
given sufficiently often to repress excitement. The 
alkaloid may be given hypodermically, and in gradu- 
ally increasing doses. With it should be associated 
other remedies, like hyoscyamus and chloral hydrate, 
in order to procure sleep. 1 

1 Kiernan, Journ. Nerv. and Mental Diseases, Vol. X, p. 234 



CHAPTEE IV. 

TREATMENT OF INSOMNIA IN PARTICULAR DISEASES. 

Take thou this phial, being then in bed, 
And this distilled liquor drink thou off; 
When presently, through all thy veins shall run 
A cold and drowsy humor, which shall seize 
Each vital spirit. 

— Romeo and Juliet. 

Excluding from consideration all cases of insomnia 
arising from painful injuries or diseases of the external 
portions of the body, which belong to the province of 
surgical therapeutics, we may profitably commence 
with the variety of wakefulness that is excited by dis- 
order of the brain and its membranes. This includes 
the different forms of meningitis, the cerebral disturb- 
ances which constitute insanity, cerebral exhaustion, 
and chronic alcoholism. 

Insomnia in acute affections of the brain. — Acute 
intra-cranial inflammations may result from general 
diseases, like rheumatism, the eruptive fevers, tubercu- 
lar infiltration, insolation, the development of tumors, 
or syphilitic growths. In all such cases the earlier 
stages are marked by a painful exaggeration of cere- 
bral function which renders sleep impossible. The 
wakefulness of this stage soon becomes complicated 
with delirium; and the whole is finally merged in a 
fatal coma, Cerebral excitement is the principal fea- 

(92) 



ACUTE- AFFECTIONS OF THE BRAIN. 93 

ture which arrests attention. This is accompanied by 
an inordinate determination of blood to the head, pro- 
ducing that cerebral hyperemia which figures so 
largely in the works of the humoral pathologists. The 
treatment of acute inflammation becomes the best 
means of relieving this excitement, allaying the hyper- 
emia, and procuring sleep. The treatment should be 
derivative, counter-irritant, and calmative. The first 
indication must be fulfilled by the exhibition of an 
active purge. Ten grains of calomel with five grains 
of sodium bicarbonate may be given for this purpose. 
Leeches or wet cups should be applied to the temples, 
or to the back of the neck. The feet should be placed 
for a short time in a hot foot-bath, and an ice-cap must 
be drawn over the scalp. The internal medication 
must consist of arterial sedatives and cerebral depress- 
ants. For the first, tincture of aconite forms an ad- 
mirable example — better even than the tartar emetic 
so much lauded by Graves. Aconite may be given 
with the bromides. When sleeplessness in an acute 
meningitis is accompanied by severe pain, an excellent 
combination will be found in the following: 



Morph. Sulph. - 


g r - i 


Chloral Hydrat, 


- 


Sodii Bromid. aa 


3iv. 


Tr. Aconit., rad. 


gtt. XXV. 


Tr. Cardam. Co. 


3i. 


Aquae, q. s. ad. 


Ii. 



Sig. — A teaspoonful every two hours, till relieved. 
As the disease progresses, the quantity of morphia 
should be reduced. In epidemic cerebro-spinal menin- 



94 INSOMNIA. 

gitis, opiates may be safely employed in much larger 
doses than are tolerated in the simple forms of 'the 
disease. When in doubt regarding the proper hypnotic 
the bromides alone should be used. Chloral hydrate 
may also be safely employed in the first and second 
stages of meningitis ; but if given in full doses near 
the close of the second stage it sometimes seems to 
hasten the appearance of coma. 

Insomnia in insanity. — Persistent insomnia is often 
one of the premonitory symptoms of insanity. It is 
likely to present itself as a most formidable complica- 
tion at any stage of the disease. To consider aright 
the relations that exist between sleeplessness and in- 
sanity would far exceed the limits of this work ; we can 
only review the leading indications for its treatment. 
It is occasioned either by an excited state of the brain, 
accompanied by hyperemia and general functional 
exaltation, or by an exhausted and irritable condition 
of the cerebral substance. The first of these two 
varieties of wakefulness is encountered in cases of 
violent maniacal excitement where the disorder is com- 
paratively recent, and the bodily vigor has not been 
depressed by long continued disease. The indications 
for treatment call for sedative measures. Leeches be- 
hind the ears and the application of the ice-cap are 
sometimes of great service. Derivative action upon 
the bowels with aloetic purgatives has often yielded 
good results. In like manner, hot mustard foot baths 
are recommended. The soothing effect of a warm bath 
at 90° — 95° F. is sometimes sufficient to calm excite- 
ment, and to induce sleep. The combined effect of 
cold applications to the scalp and a warm bath to the 



INSANITY. 95 

general surface is still more tranquillizing. This 
method of treatment is particularly useful in maniacal 
forms of insanity, and in certain cases of melancholia — 
especially those in which the skin is dry and the secre- 
tions are disordered. 

Cold affusions and shower baths have been employed 
for their revulsive and sedative effect in mania. This 
mode of treatment is sometimes effectual, but is not 
without risk. 

The medicinal treatment of insomnia is frequently 
facilitated by the measures above indicated. In cases 
of great excitement with restlessness and bodily agita- 
tion, it is desirable to arrest the movements which are 
wearying the patient and keeping him awake. This 
may be accomplished by the use of conium, as indicated 
by Kiernan (loc. cit.). Twenty minims of Squibb's 
fluid extract may be given for the first dose. Half 
this quantity should be repeated every half hour until 
the patient becomes quite calm. Bromide of potas- 
sium and hydrate of chloral in drachm doses should be 
given in connection with conium. Kecently, paraldehyde 
has been employed as a substitute for chloral. These 
remedies reduce cerebral excitement, and favor the 
induction of sleep which is at least refreshing, 
if not curative of the disease. They should not, how- 
ever, be used habitually, for fear of producing the 
characteristic consequences of over-dosing with such 
drugs. 

The varieties of insanity in which depression and 
exhaustion are the prominent features require different 
management. Nutritious food, alcoholic restoratives 
and stimulant doses of opiate remedies are most ser- 



96 INSOMNIA. 

viceable. The sleeplessness of melancholia and of 
paretic dementia may be thus relieved. Opium may 
be given in the form of a pill, or in the deodorized 
tincture. The old fashioned "black-drop" is highly 
esteemed by some. Others prefer the salts of morphia. 
If cerebral hyperemia be present in these cases, it is 
usually associated with asthenic conditions of the 
brain, indicated by paleness of the face and weakness 
of the pulse. The hyperaemic state is then easily over- 
come by the administration of alcohol or of chloral 
with an opiate. If opiates alone are given in cases of 
insanity with great depression, there is danger that 
death by syncope may occur, precisely as it sometimes 
happens in delirium tremens when treated with large 
and frequent doses of opium. 

Cases are occasionally encountered which receive 
no relief from opiates. The remedy seems only to 
aggravate the existing irritability and insomnia. For 
such patients the tincture of hyoscyamus may be em- 
ployed in doses ranging from two to four or even six 
drachms. Associated with bromide of potassium and 
hydrate of chloral, it has been used with great success. 
Spitzka prefers the simple tincture rather than the 
fashionable alkaloid, hyoscyamia. 

Cannabis indica associated with bromide of potas- 
sium is a useful hypnotic in cases of moderate depres- 
sion and excitement. Clouston finds as a result of his 
experiments that "forty-five grains of bromide of 
potassium and forty-five minims of the tincture of can- 
nabis indica are rather more than equivalent to a 
drachm of laudanum as a means of allaying maniacal 



CHRONIC ALCOHOLISM.— DELIRIUM TREMENS. 97 

excitement. 1 ' ' In his recent work, 2 the same author 
deprecates the use of opiates in states of depression, 
and advises the substitution of tincture of cannabis 
indica (xmin.) and bromide of potassium (xx grs.). 
He also emphasizes the importance of abundant exer- 
cise in the open air, as the best hypnotic in every case 
that can be trusted abroad. 

Insomnia in Chronic Alcoholism and Delirium Tre- 
mens. — The insomnia of chronic alcoholism is depend- 
ent upon the extensive morbid changes produced in 
the digestive apparatus and in the nervous system by 
the habitual use of alcoholic drinks. Sleep becomes 
greatly disturbed and unrefreshing. It is frequently 
broken by horrible dreams. The successful treatment 
of this condition requires complete abandonment of 
the use of alcohol, and a general correction of the con- 
dition of the alimentary canal. For the immediate 
relief of insomnia, full doses of bromide of sodium will 
be of service. Strong infusions of hops may be given 
ad libitum. Cannabis indica, in the form of the extract, 
so as to avoid the use of alcohol in the tincture, is of 
service. Hypodermic injections of morphia are fre- 
quently employed, but should be avoided if possible, 
for fear of the opium habit. Chloral hydrate is ex- 
ceedingly useful, but should be given in milk, and as 
seldom as possible, for fear of adding to the injuries 
already sustained by the stomach. For the same rea- 
son the use of paraldehyde in such cases is quite 
inadmissable. 

When chronic alcoholism has culminated in delirium 

x Psychological Medicine, Bucknill and Tuke, 4th ed., p. 731. 
2 Clinical Lectures on Mental Diseases. 

7 



98 INSOMNIA. 

tremens, more energetic measures become necessary in 
order to procure sleep. If the patient be of a vigor- 
ous constitution, and if the delirium be very active, 
tartar emetic with morphia may be given, as advised 
by Graves. Large doses of tincture of digitalis, some- 
times reaching an ounce every four hours, were used 
by Jones, of Jersey. Capsicum, in scruple doses every 
three hours, is said to induce sleep in many cases of 
delirium, 1 especially in exhausted conditions of the 
circulatory organs. Hydrate of chloral and bromide 
of sodium, each in scruple doses, may be given every 
two hours. Opiates should be used with moderation, 
and all attempts to induce profound narcosis should be 
avoided. Drachm doses of tincture of cannabis indica 
and of compound spirit of ether, may be given when a 
diffusible stimulant must be associated with the sopo- 
rific. In desperate cases it is sometimes necessary to 
resort to inhalation of ether, but if sudden death should 
occur, it would be popularly ascribed to the effects of 
the anaesthetic. By reason of a certain tendency to 
death from syncope during this disease, it is impru- 
dent to place such patients under the influence of 
chloroform or the other stronger anaesthetics. 

Insomnia in diseases of the heart and blood vessels. — 
I can fully indorse the opinion of Kinger regarding 
the beneficial effects of morphia in the treatment of 
the wakefulness caused by advanced diseases of the cir- 
culatory organs, " In such a case, the comfort afforded 
by a hypodermic injection is almost incredible. . 
In cardiac dyspnoea, a sixth of a grain twice or three 
times a week often suffices, but the dose and frequency 

1 Ringer's TJierapeutics, ioth ed., p. 421. 



ANGINA PECTORIS. 99 

in severe cases must be gradually increased to a quar- 
ter of a grain each night. Doctors are often afraid to 
administer morphia in the case of a patient propped 
up in bed, with livid ears, nose and nails, with dis- 
tended jugulars and dropsical extremities, with weak, 
frequent and irregular pulse. They dread lest the 
morphia should weaken the heart, make the patient 
worse, if not kill him outright. This fear is quite 
groundless," if the opiate be given in moderate doses. 
It is the stimulant effect of the medicine that is safe 
and useful. 

When wakefulness is caused by angina pectoris, or 
by simple cardiac neuralgia, such as sometimes follows 
excessive use of tobacco, relief may be obtained 
through the exhibition of alcoholic stimulants, hydrate 
of chloral, or nitrite of amyl. These remedies act 
more speedily than morphia, and may be associated 
with it, to the great advantage of the patient. They 
should not be habitually used, however, in cases of 
cardiac exhaustion, as their chronic employment favors 
accumulation of blood in the right side of the heart, 
with a tendency to paralysis of the cardiac muscles. It 
is in stenosis of the coronary arteries, and in aortic ob- 
struction, that nitrite of amyl and nitro-glycerine are 
most useful. The insomnia that results from the 
remote consequences of these diseases is often relieved 
by remedies which assist the circulation of blood. For 
this purpose digitalis is the most useful stimulant in 
mitral disease ; nitro-glycerine, in aortic valvular 
lesion. 

Insomnia in diseases of the respiratory organs. — 
Pleuritic pain and its consequent wakefulness may be 



100 INSOMNIA. 

relieved with opiates, guarded by appropriate vascular 
sedatives. Dover's powder, or morphia and aconite, 
form excellent examples of the remedies most useful, 
so long as the lungs are not overwhelmed by excessive 
exudations into the pleural cavities. Pneumonia and 
bronchitis are accompanied by wakefulness, in their 
earlier stages, as a consequence of harassing cough. 
This may be allayed by the judicious use of expector- 
ants and sedatives. If symptoms of asphyxia appear, 
indicated by blueness of the lips and nails, opiates 
should never be given. Respiratory stimulants are 
then indicated, and sleep must be allured by the use 
of alcoholic beverages and moderate doses of chloral 
hydrate, with musk and camphor. The early, irrita- 
tive cough of incipient pulmonary consumption may 
be soothed with camphor and opium. Paregoric and 
a demulcent, like Iceland moss tea, or flaxseed tea 
slightly acidulated with lemon-juice, form an excellent 
type of such a compound. But the chronic duration 
of the disease renders the constant use of opiates unde- 
sirable. Chloral hydrate, for the same reason, cannot 
be given without intermission. It is well in such cases 
to employ the different alcoholic beverages at bedtime. 
Inhalation of warm vapor, and respiration of air 
charged with ether, or carbolic acid, will often quiet 
an irritative cough. In advanced cases belladonna is 
useful, to check the profuse sweating and to calm the 
thoracic pain that hinders sleep. In the later stages 
of the disease, when relief from suffering is the only 
end in view, morphia and dilute hydrocyanic acid will 
often render quite tolerable the few, remaining nights 
of life. 



ASTHMA.— RENAL DISEASE. 101 

One of the most distressing forms of insomnia is 
occasioned by the different varieties of asthma. Dysp- 
noea is the feature that is common to them all, and is 
the principal exciting cause of wakefulness. In recent 
cases, which are characterized by spasm, the various 
anti-spasmodics are useful. Tincture of lobelia, tartar 
emetic, and ipecac, are of great service. Inhalations 
of ether or of chloroform, or of nitrite of amyl, Avill 
often cut short a paroxysm; but the nervous system 
soon becomes tolerant of their action. Chloral hydrate 
and alcoholic stimulants are less vigorous, and cannot 
be long tolerated by the stomach, especially if there be 
a gouty diathesis behind the disease. The fumes of 
burning pastiles containing nitre and stramonium 
leaves are often of great service if so breathed as to 
thoroughly fill the lungs with the smoke. In like 
manner, the smoke from smouldering nitre-paper, or 
from cigarettes that have been dipped in an arsenical 
solution, is sometimes useful. Air charged with ozone 
has been found curative in some inveterate cases. 
Hyoscyamus, belladonna, and tobacco, have been recom- 
mended. It may even become necessary to employ 
hypodermic injections of morphia. 

If, however, the disease should resist all these anti- 
spasmodics and soporifics, besides the remedies ad- 
dressed to the predisposing causes of the malady, the 
only thing that remains is a change of locality. Many 
very desperate cases have thus been restored to health 
and comfort. 

Insomnia in renal disease. — In the acute forms of 
renal disorder this, is usually caused by pain and fever. 
It is, therefore, to be relieved with opiates given in 



102 INSOMNIA. 

connection with suck arterial sedatives and diaphore- 
tics as each individual case may require. But the 
tendency of inflammatory diseases of the kidney to 
merge in uraemia must not be forgotten, and the 
soporific must be used in such cases with' great cau- 
tion. For this reason hyoscyamus is often preferable 
to an opiate. In extreme dropsical conditions the 
measures that are useful for the reduction of anasarca 
constitute the most efficient means for the induction of 
sleep. In nephritic colic pain is too severe to admit 
of any rest while it lasts. The general treatment of 
colic is all that can occupy the attention until relief is 
secured. The dyspnoea and wakefulness sometimes 
experienced in advanced cases of Bright' s disease may 
be greatly relieved by the judicious use of morphia, 
very much as in the similar disorder occasioned by 
chronic diseases of the heart. 

Insomnia in diseases of the liver. — Inasmuch as the 
majority of these diseases interfere with the formation 
and proper discharge of bile it is desirable to avoid, as 
far as possible, the use of opiates in the disturbances 
of sleep that are so commonly consequent upon 
disorder of the liver. Simple restlessness at night 
can usually be obviated by the ordinary treatment that 
is remedial of the disease by which it is caused. But 
it often happens that hypnotic remedies must also be 
employed. Hyoscyamus, belladonna, chloral hydrate, 
and compound spirit of ether, are frequently useful. 
Sometimes when the evacuations exhibit a deficiency 
of biliary coloring matter, a grain of opium, with a 
few grains of calomel, forms a very efficient hypnotic. 
Alcoholic soporifics are not well tolerated when the 



GASTRO- INTESTINAL DISEASES. 103 

gastrointestinal mucous membrane is diseased. Biliary 
colic demands treatment similar to that that is re- 
quired in nephritic attacks. Warm baths, fomenta- 
tions, and a broad belt of oiled silk around the body, 
are very grateful, and are favorable to the induction 
of sleep. A course of nitro-muriatic acid, internally 
and externally, is often useful when wakefulness is as- 
sociated with torpidity of the liver. 1 

Insomnia in gastro- intestinal diseases. — In acute in- 
flammatory conditions of the stomach and bowels, sleep 
must be invited by the use of opiates. Bismuth and 
morphia, with hydrocyanic acid, are the favorite means 
of obtaining relief. Opium in solid form is sometimes 
preferable when a slowly developed and long continued 
impression is desired. Warm baths and hot poultices 
also give great relief. 

In all chronic affections of the alimentary canal 
opiates must be used with great caution, for fear of the 
opium habit, unless the case be incurable. Cancer of 
the stomach requires their free use. The milder dis- 
orders should be managed largely with hygienic treat- 
ment. The diet should be so regulated as to prevent 
the liberation of gas in the intestines, for their disten- 
tion in this way is fatal to refreshing sleep. A gentle 
aperient or a large injection of warm water, often proves 
itself decidedly soporific in such cases. Catarrhal con- 
ditions of the mucous membrane prohibit the entire 
class of alcoholic and ethereal soporifics. Nervous 
and atonic dyspepsias are often benefitted by the use 
of bitter beer, and by drachm doses of brandy or 
whisky largely diluted. These should be taken at 

1 C. H. Jones, Functional Nervous Disorders, p. 284. 



104 INSOMNIA. 

mealtime, or with food at bedtime. A glass of hot 
water shortly before retiring is often useful. 

The relief of insomnia in dyspeptic derangement, 
however, must not be sought through the administra- 
tion of anodynes and hypnotics alone. Only when the 
entire life of the patient has been regulated upon a 
physiological basis can refreshing sleep be obtained. 
Change of habits, change of occupation, change of 
locality — these are the only curative measures in a 
vast number of the cases of wakefulness that occur in 
modern life. Alcohol, tobacco, tea, coffee, foul air, 
late hours, and mental excitement, are the principal 
causes which must be abolished before healthy sleep 
can be enjoyed. 

Insomnia in febrile conditions. — In the early stages 
of all acute fevers wakefulness is a very common inci- 
dent. It is then occasioned by irritation of the 
brain, and must, therefore, be relieved with opiates. 
If the patient is not depressed by the disease, the 
opium should be associated with tartar emetic or 
aconite, or ipecac. Dover's powder is very useful in 
such conditions. In malarial fevers wakefulness should 
be combatted with full doses of, quinine in addition to 
the opiate. Gelsemium is sometimes a very satisfac- 
tory remedy — especially in the febrile attacks to which 
children are liable. If any evidence of cerebral hyper- 
emia be observed, it is well to give chloral hydrate and 
the bromides. Hyoscyamus, belladonna, and cannabis 
indica are useful when the pupils are contracted and 
when spasmodic symptoms are present. Lukewarm 
baths, wet packs, and cool sponging are exceedingly 



FEVERS.— RHEUMATISM AND GOUT. 105 

grateful, and often assist in the evolution of a sup- 
pressed eruption in the exanthematous fevers. 

In the later stages of fever a condition of cerebral 
exhaustion is sometimes encountered. Irritable weak- 
ness caused by starvation of the brain is the prominent 
feature. The pulse is small and weak. The patient 
tosses and rolls from side to side. He is perhaps 
greatly emaciated by an illness of considerable dura- 
tion. An elevated temperature requires frequent 
sponging of the body. 

Opium, alcohol, and liquid food, are the best hyp- 
notics in such cases. The acetum opii and tlie deodor- 
ized tincture of opium are among the best preparations 
of the drug, by reason of their stimulant effect. The 
equivalent of two grains of opium with a full glass of 
eggnogg, will often procure sleep for such a patient. 
If there be evidence of blood stasis, with blueness of 
the nails, hypostatic pneumonia, etc., musk and strych- 
nia should be given in place of opium, and the circu- 
lation should be assisted with carbonate of ammonia, 
as follows: 

$. Ammon. carb., - - gr. v. 

Spt. chloroform, - gtt. xx. 

Aq. camphor, - - 3 ss. 

To be given in a little milk, as required. Chloral 
and the bromides are of comparatively little value in 
all cases where there is considerable depression of the 
vital forces. 

Insomnia in rheumatism and gout — Opium in a 
diaphoretic preparation, and associated with alkalies or 
with colchicum, has always been the most approved 



106 INSOMNIA. 

remedy for sleeplessness in the acute forms of these 
painful diseases. Salicylic acid and the salicylates 
have in great measure superseded the use of opiates 
for the relief of pain and wakefulness in rheumatism, 
but they are not always efficient. Opiates, with or 
without chloral, must then be used. Sometimes a 
painful case that has resisted all other remedial agents 
yields promptly to the action of a series of blisters. 
The chronic forms of rheumatism require the use of 
stimulant diaphoretics, anodyne liniments containing 
chloroform and belladonna, and chloral hydrate, or 
even a Dover's powder, at night. 

Acute gout is rarely seen in this country, but its 
rudimentary forms, described by Da Costa as lithcemia, 1 
are not uncommon. They are associated with wakeful- 
ness of a very troublesome character, which only yields 
to a persistent and long continued course of treatment 
directed against the diathesis. Careful regulation of 
the diet, change of air, and anti-arthritic remedies, are 
of infinitely greater service than any particular hyp- 
notic drug. 

Insomnia in syphilis. — In advanced stages of syph- 
ilitic cachexia, a variety of wakefulness independent of 
pain is sometimes observed. It is marked by a tendency 
to wake at a fixed hour of the night, frequently about 
two o'clock in the morning, after which time sleep is 
impossible. The symptoms of constitutional disease 
are not prominent in these cases, but the history and 
the evident cachexia make their nature apparent. 
They usually yield to a mercurial treatment. In 
their comparative freedom from severe pain, such pa- 

1 Am. Jour. Med. Sci., Oct., 1SS1, p. 313. 



SYPHILIS.— DISORDERS OF NUTRITION. 107 

tients present a striking contrast to certain cases of 
syphilitic rheumatism, or neuralgia. The nocturnal 
suffering in such instances is frightful. It can be 
finally overcome by anti-syphilitic treatment; but, 
while waiting for the radical cure, palliatives are 
needed. Chlorodyne and similar combinations of all 
the anodyne drugs afford the most effectual means of 
relief. I have sometimes found it necessary to increase 
the dose until the characteristic delirium produced by 
solanaceous drugs was manifested. The relief thus 
procured sometimes continues for many days after the 
cessation of hypnotic medication. 

Insomnia in various disorders of nutrition. — The 
wakefulness experienced by syphilitic patients is not 
peculiar to their cachexia. It is a result of blood dis- 
order and impoverishment that is common among the 
victims of rheumatism, lithaemia, syphilis, malarial 
poisoning, cancerous dyscrasia, chronic toxaemia of 
every form, and ordinary anaemia. Imperfect blood 
supply deteriorates the nutrition of the brain, and ren- 
ders it so excitable that sleep is interrupted so soon as 
the period of profound repose is past. This occupies 
about four hours (see p. 16), hence the patient who 
falls asleep at ten o'clock is ready to wake up at two in 
the morning, and only sleeps again, if at all, when 
wearied with tossing till daylight. Such patients often 
derive great benefit from a morning nap thus obtained 
between the hours of five and seven. 

The most successful treatment of this variety of 
insomnia is that form of medication which is addressed 
to the particular cause of the cachexia or dyscrasia. 
But the palliative treatment necessitated by the imme- 



108 INSOMNIA. 

diate suffering of the patient will often tax to the utter- 
most the ingenuity of the physician. Usually, there is 
a chronic atonic dyspepsia, or a chronic catarrhal gas- 
troenteritis, or a combination of both conditions, to be 
remedied. Gently stimulating laxatives are needed 
for the relief of these disorders. An animal diet is 
most easily digested. Milk and rare beefsteaks supply 
this form of nutriment, to which must be added 
oranges, grapes and lemons, to prevent the develop- 
ment of incipient scurvy. The kidneys may be ex- 
cited with small doses of iodide of potassium or chlo- 
rate of potassium. Only after a considerable course 
of elimination are " tonics " admissible. For the 
immediate relief of the insomnia by which the patient 
is exhausted, a rather complex method is needful. 
Such subjects often pass the day in tolerable comfort, 
but, as evening advances, the wearied brain becomes 
irritable, and bedtime finds the patient in an excited 
state which cannot be easily overcome by large and 
repeated doses of chloral. Paraldehyde is too disa- 
greeable to be used with impunity, and only towards 
morning does the sufferer yield to the narcotism 
induced by successive doses of chloral and bromide. A 
night thus occupied adds nothing to the vigor of the 
individual, and its frequent repetition will most surely 
lead to starvation of the nerve-centers, — perhaps to 
consequent "chloral-mania." 

When the tendency to cerebral irritation becomes 
thus apparent, great assistance can be obtained by a 
resort to the use of opium, combined with tartar emetic 
and camphor. A pill containing one grain each of 
opium and camphor, with one-twelfth or one-sixteenth 



PREGNANCY AND PARTURITION. 109 

of a grain of tartar emetic, should be given early in the 
evening. This calms the brain, and prepares the way 
for a moderate dose of chloral at bedtime. In this 
way sleep can be procured with much less expenditure 
of nervous force and medicine than is wasted in the 
ordinary routine method. The rest thus obtained is 
followed by less depression than when it follows stu- 
pefaction with large quantities of an exciting nar- 
cotic. 

Insomnia during pregnancy, and after parturition. — 
Closely akin to the insomnia of anaemia is the wakeful- 
ness experienced by hysterical subjects. The irritable 
weakness of their brains renders them peculiarly liable 
to disturbances of sleep. The state of pregnancy 
often serves to fill their nights with excitement suffi- 
cient to interfere with quiet rest. Loss of blood 
during parturition, by the induction of temporary anae- 
mia, may greatly aggravate this condition. 

The suppression of nervous irritability is the prin- 
cipal indication for treatment. This may be tempora- 
rily accomplished by the use of the bromides. But these 
must be reinforced by an ample dietary, with stimu- 
lant nervines and anti-spasmodics. Good wine, cam- 
phor, valerian, hyoscyamus, cannabis indica, and 
occasional doses of opium, will generally suffice to 
induce the needful repose. If confinement in bed 
precludes muscular movement for any length of time, 
passive exercise must be secured through the aid of 
massage. 

Insomnia in spasmodic diseases. — This class 
of ailments will usually be encountered among pa- 
tients who are enfeebled by unfavorable condi- 



110 INSOMNIA. 

tions of health, either congenital or acquired. To- 
gether with the specific treatment appropriate to the 
particular disorder, it often becomes necessary to 
make use of hypnotic remedies against sleeplessness. 
Thus chorea may sometimes reach a degree of invet- 
eracy that renders sleep impossible. Alcohol and 
chloral hydrate must then be given in large and fre- 
quent doses. A laryngeal catarrh may excite spas- 
modic croup — a disorder speedily relieved with chloral 
hydrate. Old people of a nervous temperament some- 
times experience paroxysms of a similar character, 
interfering with sleep whenever they suffer a catarrhal 
attack. Liberal doses of assafcetida and a Dover's 
powder at night, associated with a course of anti- 
lithic treatment, afford great relief. Iodide of potas- 
sium, in the majority of asthmatic affections ; the bro- 
mides and gelsemium in cases marked by excitability 
of the spinal cord; valerian, musk, assafcetida, cam- 
phor, and carbonate of ammonia, in cases of cerebro- 
spinal weakness and irritability ; oxide of zinc, quinine, 
and chloral hydrate, when weariness and exhaustion 
are connected with a hypersemic condition of the brain ; 
such are the principal remedies against this variety of 
insomnia. Convulsions, if frequently repeated, may 
be subdued by the inhalation of ether or chloroform, 
until a sufficient quantity of the bromide of potassium 
can be introduced into the system. 

Insomnia in childhood. — According to Vierordt, 1 
the duration of sleep in the first week of life is only 
interrupted by the act of nursing. During the first 
month the infant should sleep at least two hours after 

1 Handbuch der Kinder krankheiten, Vol. I., p. 214. 



INSOMNIA IN CHILDHOOD. HI 

each meal, waking only three or four hours out of the 
twenty-four. This period gradually increases; but, 
when a year old, the healthy child still sleeps more 
than he wakes. During the second and third years, 
he should sleep for ten or eleven hours at ,night, be- 
sides a nap of two hours in the daytime. After the 
fourth or fifth year, the daily nap may be discontinued. 
The fifth and sixth years require ten hours of sleep at 
night. From the seventh to the eleventh year, nine 
hours are needed. After the twelfth year, eight hours 
are sufficient. 

The causes of wakefulness are as numerous among 
children as among adults. Jacobi 1 insists upon the 
importance of attention to the ventilation of the bed- 
chamber, and to the quality of the bed. Everything 
must be light, airy and cool. He gives utterance to 
universal experience when he asserts that great heat 
can be endured by day without harm, if only the night 
brings coolness and rest. 

Hunger is sometimes a cause of wakefulness among 
young children. Partial starvation endured for a 
considerable time induces somnolence. The opposite 
condition of repletion may also excite wakefulness 
through painful distension of the stomach and bowels. 
Earache, terminating in abscess, often prevents sleep, 
sometimes without discovery of the cause until a dis- 
charge of pus enlightens the diagnosis. Persistent 
wakefulness without evident cause should arouse a sus- 
picion of incipient tubercular meningitis. Slight 
elevations of temperature at night sometimes occasion 

x 0p. cit., Vol. I., Pt. 2, p. 153. 



112 INSOMNIA. 

sleeplessness, which may be overcome with quinine in 
doses of two to five grains at bedtime. 

Wakefulness sometimes occurs merely as the result 
of a bad habit. This is usually observed among deli- 
cate children of a nervous temperament, whose inclina- 
tions have never been thwarted. Such patients have 
been sometimes cured, after the failure of a long and 
expensive course of treatment with homoeopathic 
globules, by the adoption of a systematic moral train- 
ing reinforced by an occasional forcible application of 
the parental hand to the gluteal region of the child. 
Of course such a method must not be recommended 
without certain knowledge that no lurking disease of 
the nervous system has escaped detection. Fretful- 
ness and wakefulness are not associated with proper 
living and good health. Their cause must generally 
be sought upon the surface of the body and in its in- 
ternal cavities. 

Much relief in the insomnia of children can be 
obtained from the use of lukewarm baths at bedtime. 
Supper should be a light but sufficient meal. Every 
disorder of digestion should be regulated as it occurs. 
Painful affections may be quieted with Dover's 
powder. Feverish and irritable conditions yield fre- 
quently to aperients, or to gelsemium and quinine. 
Night terrors and screaming fits should be calmed 
with chloral hydrate and the bromide of sodium. As 
a general sedative and hypnotic for children hyoscya- 
mus has an excellent reputation. It may be given in 
considerable doses with perfect safety and the best 
results. For patients in early life it seems to fill the 



OLD AGE. 113 

place occupied by cannabis indica in the medication of 
adults. 

Insomnia in old age. — The highest physical perfec- 
tion is reached before the fortieth year of life. Be- 
tween this age and the forty-fifth year man's vigor 
begins to decline. The power of accommodation 
diminishes, necessitating the use of spectacles ; adipose 
tissues begin to load the body; the hair grows thin, 
and begins to bleach. The processes of nutrition and 
of disassimilation become more sluggish ; the appetites 
and passions gradually subside. Sometimes the mod- 
eration of nervous excitability thus effected permits 
indulgences of the appetite for food that were im- 
possible during earlier years — the nervous dyspeptic 
can tolerate dainties which would formerly have been 
unendurable. Less disturbed by the solicitations of 
sense, the powers of reasoning and of judgment 
enlarge their authority. Under favorable circum- 
stances this period of life may continue for about 
twenty years, when old age developes. From the six- 
tieth to the eightieth year the progress of decline is 
rapidly accelerated, and life is normally terminated 
between the eightieth and eighty-fifth years of exist- 
ence. The rare examples of greater longevity are too 
few in number to warrant the assumption that a cen- 
tury of years is the physiological complement of life. 

As old age advances, the time of sleep is slightly 
abridged. The moderated activity of the body requires 
only a diminished rate of repair to make good the 
waste of the tissues. Less sleep, therefore, is needed. 
But the liability of age to the incidence of arthritic 
diseases, rheumatism, and disorders of the heart, 
8 



114 INSOMNIA. 

blood vessels, digestive apparatus, and urinary organs, 
renders the period of decline particularly subject to 
those varieties of sleeplessness which depend upon 
such derangements of health. The nutrition of the 
brain suffers under such circumstances, and the sub- 
stance of the organ becomes morbidly irritable. In- 
somnia among the aged often owes its cause to these 
unwholesome conditions. The biography of the cele- 
brated Carlyle affords numerous illustrations of this 
variety of wakefulness. Disease of the cerebral blood 
vessels sometimes originates a series of changes differ- 
ing only in degree and intensity from the classical 
type of chronic periencephalitis. This is character- 
ized by many of the minor phenomena of general 
paresis, only occasionally rising to the level of that 
disease. Wakefulness is one of the most troublesome 
symptoms of this disorder. Its management requires 
attention to all the details of excretion and nutrition. 
The diet must be carefully selected with reference to 
failure of the digestive function. Milk and water 
should be preferred for drink, and the great emunctory 
organs of the body must be carefully stimulated and 
sustained. A judicious choice of climate may accom- 
plish much for the comfort of the patient. The mild, 
insular climate of Florida, or of New Providence, or 
of the Sandwich Islands, affords superior advantages 
for the relief of sleepless sufferers in the northern 
temperate zone of the American continent, who need 
the soothing influence of a continual open air bath. 

During the latest stages of decline, when the cortex 
of the brain has become considerably atrophied, the 
opposite of wakefulness is experienced. Intellectual 



OLD AGE. 115 

operations become less vigorous, and the patient passes 
lengthening periods of time in sleep. This is a genu- 
ine relapse into the apathy of infancy. The apparatus 
of thought is worn out, and the old man sinks gradu- 
ally into the sleep from which there is no awakening. 
The treatment of insomnia, therefore, resolves itself 
into the removal of all special and temporary causes of 
wakefulness, with attention to the general hygiene of 
the patient, and careful regulation of his diet, habits, 
and occupation. Pain must be quelled with anodynes. 
Cerebral excitement must be calmed, in sthenic cases, 
with anti-spasmodics and sedatives — in asthenic sub- 
jects it must be overcome with food and nervous stimu- 
lants. Since many patients present a combination of 
these apparently opposite conditions, there is room for 
a great display of penetration and tact in the manage- 
ment of complex cases. While seeking for the imme- 
diate relief of present suffering, the ulterior conse- 
quences of treatment must always be kept in view, and 
the particular cachexia or dyscrasia must be thoroughly 
appreciated by the physician in his choice of remedies. 



CHAPTEK V. 

DBEAMS. 

Behold, this dreamer cometh ! 

Gkxesis, XXXVII. 19. 

The harmonious activity of all parts of the nervous 
system is indispensable to the highest exercise of the 
conscious mind. Healthy intellectual life is the per- 
fectly balanced outcome of the complex polygon of 
forces which has its seat within the brain. In the 
waking condition this " moving equilibrium," as it has 
been happily termed, 1 is sustained by the convergent 
impulses which are continually entering the brain 
through the pathways afforded by the several senses. 
Our waking hours are occupied with the ideas and 
with the associated trains of thought which are thus 
projected upon the field of consciousness. As a con- 
sequence of the harmonious function of the organs of 
sense, each one supplementing and correcting the 
information furnished by the others, a continuous pro- 
cess of perception and logical thought is maintained. 
But, along with the procession of ideas which are 
clearly conceived by the mind, the field of conscious- 
ness is also invaded by a cloud of half formed percep- 
tions, which are too imperfect and fleeting to occupy 
the attention. As in the act of vision, though the 

1 Herbert Spencer, First Principles, p. 486. 
(116) 



DREAMS. 117 

periphery of the visual field is crowded with a whole 
world of objects dimly perceived without challenging 
particular attention, only the center of that field fur- 
nishing clear images to the brain, so the eye of the 
mind comprehends only a few of the impressions 
which enter the sphere of consciousness. The swarm 
of unnoticed perceptions, however, is none the less the 
result of abiding sensory impressions graven in the 
substance of the brain, from which, through the action 
of memory, they may at any favorable moment reenter 
consciousness. Bleep does not wholly arrest this pro- 
V certain amount of projection into the field of 
consciousness continues, even during profound repose; 
and the ideas thus aroused form the material of our 
dreams. 

It has already been remarked that the invasion of 
sleep is not an instantaneous process. One by one the 
senses fall asleep, and long before the final cessation 
of their activity, sleepiness hinders their function. 
Hence a progressive narrowing of the range of exter- 
nal perception; hence a reduction of the vividness of 
impressions derived from the outside world; hence, 
also, a simplification of the actions and reactions 
which constitute the " polygon of forces " active within 
the brain. But the suppression of certain lines in this 
polygon does not suppress life, nor does it necessarily 
destroy consciousness. It only occasions a redistribu- 
tion of force, and a proportionate narrowing of the 
stream of related ideas. Since this process of sup- 
pression, just mentioned, is not an absolute quantity, 
but a variable factor, the polygon of physical forces 
within the brain and the corresponding succession of 



118 INSOMNIA. 

ideas in consciousness must necessarily be in a state of 
continual change. Consequently, our dreams must be 
as variable as the clouds that drift upon the currents 
of the air. As, on a hot day in summer, when the 
equatorial draught has ceased to guide the wind, we 
may observe all manner of local tides among the 
masses of vapor which arise from the earth, so, in 
sleep, when the guiding influence of the senses is with- 
drawn, the ideas that still arise are chiefly dependent 
for their origin and association upon the automatic 
and endogenous activities of the brain. Undisturbed 
by impulses from the external world, the brain seems 
then to become more sensitive to impressions that have 
their origin within the body. An overloaded stomach, 
an enfeebled heart, a turgid sexual apparatus, or an 
irritable nervous ganglion, may become the source of 
irregular and uncompensated impulses which, without 
disturbing the organs of special sense, may invade the 
cerebral cortex, and may there set in motion a whole 
battery of mechanisms whose influence upon conscious- 
ness would remain quite unnoticed were the external 
senses in full operation. 

Still another cause for the production of dreams is 
to be found in the more or less complete suspension of 
the power of volition which accompanies sleep. Every 
act of attention is the result of exercise of the will. 
But the perfect exercise of the will is dependent upon 
the perfect development and wakefulness of the brain. 
So soon as sleep begins to invade the brain, the will 
begins to lose its normal incitement to action, and 
finally it becomes almost wholly disconnected from the 
muscular organs. In this state the sleeper may desire 



DREAMS. 119 

to perform some act — he may wish to move his limbs 
or to cry out aloud, but he can move neither hand nor 
foot, he cannot utter a sound. In other instances a 
partial connection between the will and the locomotive 
organs persists, and various orderly movements can 
still be produced. In like manner the control of the 
will over the succession and association of ideas may 
be either wholly, or only partially, lost in sleep. The 
deeper the sleep the more complete the loss of such 
control; hence the greater incoherence as well as fee- 
bleness of impression which is characteristic of dreams 
when sleep is profound The vivid and panoramic 
succession of visual conceptions which constitutes a 
•vision," occurs during light and partial sleep, when 
the will is still capable of in some measure guiding 
the procession of id< 

For a similar reason the higher faculty of judg- 
ment, and especially the power of arriving at moral 
conclusions, is in great measure suspended during 
sleep. Like the power of volition, the activity of the 
moral sense is dependent upon a certain functional 
perfection in the brain. When the capacity of the 
brain is depressed by drugs or by disease, or by sleep, 
the moral sensibilities are the first to disappear. Hence 
the non-moral character of the impressions usually 
experienced during the act of dreaming. We feel 
neither surprise nor regret at the incidents of ordinary 
dreams. It is only when the border line of wakeful- 
ness is reached that the dreamer feels ashamed of 
walking naked in his dream, or feels compunction for 
an act of crime, or experiences emotions of joy or sor- 
row in connection with the incidents of his vision. 



120 INSOMNIA.. 

A dream may, therefore, be defined as the occupa- 
tion of the field of consciousness during sleep by a 
succession of ideas more or less completely withdrawn 
from the guidance of the senses and from the control 
of the will. A great variety of dreams may thus be 
admitted, ranging all the way from those products of 
mere absence of mind which constitute revery, down to 
the faintest and feeblest stirrings of consciousness 
which have been always observed during the act of 
waking from the profoundest sleep. 

Considerable light may be thrown upon the produc- 
tion of dreams if we consider attentively the manner in 
which illusions and hallucinations are excited by the 
use of drugs or by disease during the waking state. 
When engaged in experimenting upon myself with 
different medicines, I once took a dose of hasheesh 
sufficient to produce the peculiar effects of the drug. 
Sitting quietly in my chair, the first unusual sensation 
was an agreeable feeling of coolness diffusing itself 
over the surface of the body, as if some one were 
gently fanning me on a hot day. A feeling of cause- 
less amusement began to occupy my mind. I seemed 
to be smiling all over without any apparent reason for 
hilarity. Then the walls of the room in which I sat 
seemed to recede to a vast distance. My attention be- 
came riveted upon a little picture which hung against 
the wall before me. It was a sunset scene, painted 
upon a canvas scarcely larger than my hand. As the 
wall upon which it was placed seemed to recede, the 
canvas expanded until I beheld a glorious landscape 
bounded by a range of snow-capped mountains flushed 
with purple light from the setting sun. As I sat, ad- 



DREAMS. 121 

miring this splendid scene, the gilded frame of the 
painting became alive with winged fairies and cherubs, 
peeping out from behind the moulding, and bending 
over its margin to look into the picture. Then the 
ceiling of the room and* the sky of the picture seemed 
to blend in one common expanse of ethereal blue; the 
sunlight faded from the mountain peaks ; stars began 
to appear in the firmament; the little imps and fairies 
disappeared; and, presently, everything resumed its 
natural appearance. 

In this experience the departure from healthy cere- 
bral function consisted in an exaltation of certain forms 
of sensibility while others were depressed. The suc- 
cession of visual images was initiated by the visible 
objects around me, but it was enriched by the associa- 
tion of ideas furnished through the stimulation of 
memory. The sunset glow, the snow-capped moun- 
tains, the starry sky, were familiar objects, suggested 
from memory by the items grouped in the picture. In 
like manner, the cherubs who climbed upon its gilded 
frame were merely the glorified products of memory, 
probably suggested by the fact that it was a picture 
upon which my attention was fixed — one picture re- 
minding me of others which I had seen. The loss of 
proportion in the view — the exaggeration and distortion 
of all the relations of time and space, which made the 
unreal seem real, and conferred grandeur upon com- 
monplace objects, was undoubtedly occasioned by a 
modification in the molecular structure of the organs 
of special sense and of perception under the influence 
of hasheesh. The change thus effected was of a 
character to diminish the force of sensory impressions 



122 INSOMNIA. 

derived through the aid of the muscles and nerves of 
the eye and the ear and the skin, while at the same 
time exaggerating the processes of memory and asso- 
ciation in connection with impressions originating 
within the brain. In this way was produced a sort of 
confusion between the external world and the ideal 
world within, rendering it difficult to distinguish the 
one from the other. Hence the impossibility of esti- 
mating aright the relation of time and space to the 
visual impressions upon which attention was fixed. 
The result was a waking dream which differed from 
ordinary revery chiefly in the intensity of the impres- 
sions that occupied the mind. 

A somewhat similar process is sometimes experi- 
enced as a consequence of cerebral disorder uncon- 
nected with the effects of drugs. During the invasion 
of measles, having taken no medicine but sage tea, I 
remember, as night approached, a strange succession 
of illusions. My head seemed to expand to the size of 
a bushel basket ; then it would slowly contract again. 
My body seemed to grow out of shape into the most 
distorted forms of rickets. Audible sounds seemed to 
come from the most remote distances. Impending 
shadows of a great darkness hovered over the bed. 
Waves of heat, and tingling darts of numbness 
traversed my limbs. These singular and rather un- 
comfortable sensations continued until relieved by an 
ordinary Dover's powder. 

In this experience the confusion of ideas, though 
less agreeable, was essentially similar to that occa- 
sioned by the action of the hasheesh. In both cases 
there was the same diminution of the intensity of ex- 



DREAMS. 123 

ternal sensation accompanied by an exaggeration of 
internal impressions. The brain and the nerves were 
in a condition of irritable weakness, caused by disease, 
which interfered with the normal generation and asso- 
ciation of ideas. Having thus partially escaped from 
the control of the senses and the will, the mutilated 
succession of ideas which reached the field of con- 
sciousness could only be perceived as a series of illu- 
sions. Here, again, was a waking dream, of origin 
and course analogous to the illusions and hallucina- 
tions which accompany every form of delirium. 

It is not alone under the influence of disease or of 
drugs that the automatic action of the brain furnishes 
ideas for the inspection of the mind. Riding, one day, 
in a street-car, and reading a philosophical work, I 
came upon a paragraph devoted to a discussion of the 
doctrine of the association of ideas. Immediately, out 
of memory, flashed a momentary vision of the quarter 
deck of the old frigate, United States, upon which 
appeared the figure of a very small midshipman, talk- 
ing to a gigantic personage, the captain of the ship. 
This was an incident which I had actually witnessed 
forty years before. I was, at first, somewhat puzzled 
in the attempt to account for the occurrence of a vision 
so apparently incongruous with the subject matter of 
the book ; but a little reflection convinced me that the 
exciting cause of this seemingly involuntary act of 
memory was really the idea of association suggested 
by the book. This had unconsciously aroused the ap- 
paratus of association in the brain, and the particular 
scene thus brought before the mind had been further 
suggested by the circumstance that the last object, 



124 INSOMNIA. 

external to the printed page, upon which I had fixed 
my attention, was a large ship, lying in the river, near 
the bridge, just crossed by the car in which I rode. 

Numerous other examples of a similar character 
might be related to illustrate the fact that the brain 
is a reservoir of sensory impressions, some of which, 
at the moment of their original incidence, have aroused 
the mind to a greater or less degree of conscious atten- 
tion, and have then all lapsed into a latent or potential 
condition. But, though latent, they are none the less 
persistent, and only await the suppression of other 
inhibitory forces to become once more capable of arous- 
ing attention. Such inhibitory impulses are continu- 
ally furnished by the action of the sensory organs on the 
one hand, and by the energy of the mind upon the other. 
So soon, therefore, as the organs of sense and of volun- 
tary impulse are sealed with sleep, if the remaining 
portions of the brain are still operative, and are left to 
their own unrestrained activity, a more or less disorderly 
series of ideas occupies the mind. This constitutes a 
dream. The difference, therefore, between waking 
thought and a dream is analogous to the difference 
between a page upon which the words have been 
arranged in a rational order, and another page upon 
which some of the same words have been set down at 
random. Inasmuch as the majority of our sensations 
are derived through the organs of sight, and since the 
larger portion of the sensory region of the cortex of 
the brain is concerned in the act of vision, it is no 
more than might be expected that the ideas suggested 
in sleep should generally proceed from the visual ap- 
paratus of the brain. The superior power of visual 



DREAMS. 125 

impressions to attract attention may also serve to ex- 
plain the fact that the majority of dreams are composed 
of images that were originally perceived in the act of 
vision. Hence our dreams, for the most part, consti- 
tute a series of pictures undisturbed by sound, or by 
other forms of sensation. But this is not always so. 
It is highly probable that when the organs of external 
sense are allowed to sleep without disturbance, our 
dreams consist of visual impressions alone. But, if 
any unusual sound, or smell, or other sensation is 
experienced during sleep, it may penetrate the field of 
consciousness, and may become the starting point of a 
dream quite filled with sounds. Thus a young lady, 
who had passed the evening at a musical concert, was 
aroused, soon after retiring, by the striking of a clock 
which had been recently placed in her chamber. At 
the moment of waking, she was dreaming of an orches- 
tral performance of Wagner's music. Doubtless the 
dream was suggested by the unaccustomed sound of 
the clock. 

The possibility of thus suggesting, and in some 
degree guiding, the form and course of a dream, has 
been often demonstrated. 1 One of my early school- 
mates, a boy of remarkably susceptible nervous tem- 
perament, furnished an excellent example of this spe- 
cies of direction. Tickling his nose with a straw made 
him dream that a dragon-fly was assaulting his face. 
On another occasion, a few drops of vinegar placed 
upon his tongue caused him to dream of eating oranges. 
Again, one of his companions roguishly breathing in 
his ear the statement that the schoolmaster was after 

'A. Maury. Le Sommeil et les Reves, p. 154. 



126 INSOMNIA. 

him with a long rattan, he bounded out of bed, and 
could scarcely be restrained from bursting out of doors 
in his evident alarm. I was myself awakened, one 
night, by the ringing, as it seemed, of my doorbell ; 
but, hastening at once to the door, no one was there. 
As I was expecting a call from a certain patient, I con- 
cluded that the bell had been rung by an impatient 
messenger who could not wait. Falling again asleep, 
I was a second time startled by a similar ring. Look- 
ing out of the window above the door, it was evident 
that no one was there. I finally concluded that the 
sound must have been perceived in a dream, and I 
recalled the fact that each time, as I woke, the sound 
of a carriage, passing the house, had attracted my 
attention. Undoubtedly, the state of expectancy in 
which I was sleeping had operated as the predisposing 
cause of dreaming, and the noise of wheels upon the 
pavement had served as the exciting cause of a dream 
in which the sound-vibrations communicated to the 
brain had produced by an association of ideas the par- 
ticular perception which, though asleep, I was waiting 
to receive. 

In certain cases the impression produced by a dream 
is so vivid that a considerable time after waking must 
elapse before it can be relegated to its true position in 
the world of hallucinations. Dreaming, once, that my 
wife called to me from another room, I instantly awoke ; 
and only the fact that she was with me could satisfy 
me that it was all a dream. Taine ' relates that " M. 
Baillarger dreamed one night that a certain person had 
been appointed editor of a newspaper; in the morning 

1 On Intelligence, p. 61. 



DREAMS. 127 

he believed it to be true, and mentioned it to several 
persons who were interested to hear it; — the effect of 
the dream persisted all the forenoon, as strongly as 
that of a real sensation ; at last, about three o'clock, as 
he was stepping into his carriage, the illusion passed 
off; he comprehended that he had been dreaming." 

The following incident from the experience of Prof. 
Jessen, physician to the insane asylum in Homheim, 
near Kiel, 1 still further illustrates this form of halluci- 
nation : 

"On a wintry morning," writes the professor, "be- 
tween five and six o'clock, I was aroused, as I thought, 
by the head nurse, who reported to me that some peo- 
ple had come for one of the male patients, and who at 
the same time asked me whether I had any particular 
orders to give. I replied that the patient might de- 
part, and after he had left the room I turned around 
to go to sleep again. All at once it struck me that I 
had previously not heard anything regarding the in- 
tended departure of this patient, but that only the 
prospective departure of a woman of the same name 
had been reported to me. This compelled me to in- 
quire more particularly after the circumstances, and 
accordingly I lighted a candle, rose, dressed myself, 
and went to the room of the head nurse. To my sur- 
prise I found him only half dressed, and, in reply to 
my inquiry after the people who had called for the 
patient, he said, with an expression of astonishment, 
that he did not know anything of it, as he had but just 
left his bed, and no one had called him. This answer did 

1 Wharton and Stille's Medical Jurisprudence \ Third Edition, Vol. 
I, p- 482. 



128 INSOMNIA.. 

not arouse my consciousness, but I rejoined that then 
the steward must have been in my room, and that I 
should accordingly go to see and ask him regarding 
the matter. When descending a few steps in the mid- 
dle of the corridor which led to the room of the stew- 
ard, I suddenly became conscious of having dreamed 
only what until that moment I had believed to be an 
experience whose reality I had not doubted in the 
least." 

In some instances the fact of having dreamed is 
never recognized, and the dreamer carries through life 
the delusion that his vision was an actual occurrence. 
Among the Indians of Guiana, and the same thing is 
true of many other savages, dreams are looked upon as 
actual events in which the dreamer is visited by spirits 
or even by other living men. A recent English 
traveler 1 says: "It becomes important, therefore, 
fully to recognize the complete belief of the Indian in 
the reality of his dream-life, and in the unbroken con- 
tinuity of this with his working life. It is easy to 
show this belief by many incidents which came under 
my notice. For instance, one morning, when it was 
important to me to get away from a camp on the 
Essequibo Eiver, at which I had been detained for 
some days by the illness of some of my Indian com- 
panions, I found that one of the invalids, a young 
Macusi, though better in health, was so enraged against 
me that he refused to stir, for he declared that, with 
great want of consideration for his weak health, I had 
taken him out during the night and had made him haul 

1 Among the Indians of Guiana. By Everard F. Im Thurn. Lon- 
don: 1883, p. 344. 



DREAMS. 129 

the canoe up a series of difficult cataracts. Nothing 
could persuade him that this was but a dream, and it 
was some time before he was so far pacified as to throw 
himself sulkily into the bottom of the canoe. At that 
time we were all suffering from a great scarcity of 
food, and hunger having its usual effect in producing 
vivid dreams, similar effects frequently occurred. More 
than once the men declared in the morning that some 
absent men, whom they named, had come during the 
night and had beaten or otherwise maltreated them; 
and they insisted upon much rubbing of the bruised 
parts of their bodies." 

It is highly probable that from these facts, and 
from others of a similar character, may be derived the 
true explanation of many of the supposed examples of 
intercourse with divine or angelic persons which oc- 
cupy so important a place in early mythology. An 
incident in the childhood of the prophet Samuel can 
scarcely admit of any other interpretation. In other 
cases, notwithstanding the intensity of the dream, its 
true character is recognized by the dreamer during the 
very act of vision. Thus, I once dreamed that I saw a 
young girl standing before me. So vivid was the per- 
ception, that the actual presence of such a person could 
not have produced a more perfect impression upon the 
waking brain. Yet, at the same instant, I compre- 
hended the fact that it was merely a dream, and re- 
marked the difference between the intensity of the 
visual image in this and in other dreams. Such speedy 
recognition of the hallucination does not always accom- 
pany the act of waking out of a dream. In some 
cases, as we shall have occasion to see, the images 
9 



130 INSOMNIA. 

which have figured in a dream are still perceived for a 
certain period of time after awaking. 

The majority of dreams are composed of visual 
images. The dreamer looks upon a picture which 
changes silently before his eyes, without appealing to 
any other sense than that of sight. But in certain 
cases any other sense may become excited, producing 
illusions or hallucinations as perfect as the images of 
healthy vision. They may be suggested by external 
impressions, as in my dream of a ring at the door bell, 
which proved to be an auditory illusion excited by the 
sound of passing carriage wheels ; or they may, at least 
apparently, find their starting point in accidental states 
of the bodily organization. If attention be paid to this 
matter, it will be observed that all unusual modes of 
dreaming, and all extraordinary vividness of dream- 
impressions can be connected with some departure 
from the physiological conditions of quiet sleep. 
Either disease, or exhaustion, or emotional disturb- 
ance, or narcotic intoxication of the brain may be 
noted as the immediate cause of such derangement of 
the cerebral functions. After drinking several cups of 
coffee before retiring, I dreamed of a large yellow 
flower which exhaled a very fragrant odor. During 
the same night I also dreamed of drinking wine, which 
agreeably excited the senses of taste and of smell. 
Upon another occasion, having been disturbed by the 
entrance of burglars into my house, I dreamed that a 
burglar was fumbling under my pillow, and was raising 
my head and shoulders with the mattrass upon which 
I slept. I seemed to feel the changes of pressure and 
of contact as distinctly as if awake. The connection 



DREAMS. 131 

of voluptuous illusions with erotic dreams is too 
familiar to require particular mention. 

Dreams are not always limited to the revival and 
combination of the images of sensation. Intellectual 
combinations are sometimes thus presented to the 
mind The most familiar illustrations of this fact are 
furnished by the experience of mathematicians who 
have worked out mathematical problems in their 
dreams. One of my patients, an expert book-keeper, 
dreamed of adding up six columns pf figures at once. 
In the morning he still remembered his dream; and, 
on adding up the columns, found that he had actually 
produced the right sum in each case. A college 
student of my acquaintance, who was puzzled by a 

•metrical proposition, wrote out the correct solution 
during his sleep. This was something more than 
simple dreaming; it trenched upon actual somnambu- 
lism. Another acquaintance dreamed of being in 
heaven, and, while there, experienced relief from doubt 
regarding certain theological doctrines which had pre- 
viously exercised his mind. I have myself composed 
several sentences during the course of a dream, and 
have, while dreaming, sometimes esteemed them worthy 
of preservation ; but my waking recollection has never 
coincided in this particular with the opinions formed 
during sleep. 

Great difference between dreams may be remarked 
in their coherence and continuity of evolution. Some 
are composed of the most inconsistent elements without 
order or logical arrangement. In others the incidents 
follow very closely in the line of a natural and rational 
development, so that the dreamer seems to be present 



132 INSOMNIA. 

as a spectator of a perfectly coherent drama. It is 
probable that these differences depend upon variations 
in the degree of completeness with which the different 
parts of the brain and of the body are overwhelmed by 
sleep. If different and widely separated portions are 
sufficiently wakeful to suggest ideas to the mind, the 
resulting congeries will consist of discordant and in- 
coherent elements. But if wakefulness is limited to a 
particular organ of the body or to a circumscribed ter- 
ritory of the brain, the resulting impressions in con- 
sciousness should be correspondingly restricted, and 
will manifest a more orderly connection with each 
other. In some cases a tendency to simultaneous 
wakefulness of particular portions of the cerebral 
register seems to become habitual, so that the same set 
of ideas may be often renewed in the same order dur- 
ing sleep, constituting a repetition of the same dream. 
In this way I have frequently dreamed of a volcanic 
eruption 01 molten lava from a lofty mountain. This 
frequent revival of the same train of images is prob- 
ably due to the fact that in childhood I actually wit- 
nessed a volcanic outbreak, and that a very highly 
colored picture of Vesuvius in eruption hangs in my 
sitting room, so that my brain has become profoundly 
impressed with this particular image. When other 
portions of the brain are asleep, if the special region 
concerned with this picture be aroused, the mind re- 
ceives the same impression which it received when first 
excited by that portion of the organ of memory. 

As a general thing, however, dreams do not possess 
any such compactness and coherence. They are 
usually derived from many different portions of the 



DREAMS. 133 

cerebral organ, even when they seem to exhibit a 
fluently connected course. Thus, I dreamed, one 
night, that I was walking in a garden filled with pecu- 
liar oriental shrubbery. In this garden I discovered 
one of my brothers and a friend, who is widely known 
in literary circles, engaged in flying a kite. With 
great adroitness they had succeeded in causing the 
kite-string to describe in the air the outline of the let- 
ter Z. I congratulated them on the adoption of so 
truly scientific a method of kite-flying; telling them, 
also, that I had once succeeded in making a kite-string 
describe a fourth line, thus : _N- As they expressed 
surprise at this, I told them that in the May number 
of the Atlantic Monthly, for 1883, they would find an 
article on this method of kite-flying, written by Oliver 
Wendell Holmes. 

Nothing can seem more absurd than such a sequence 
of ideas. They follow each other without a break, yet 
without any logical coherence, very like the order in 
which ideas arise to occupy the mind of an insane per- 
son. Indeed, such dreams suggest the doctrine that 
the condition of a dreamer's brain is functionally iden- 
tical with what obtains in certain forms of insanity. 
At first sight it would seem as if such a dream could 
have no possible basis in fact. But a brief retrospec- 
tion enabled me to trace each individual item to its 
source in memory, and I was able to construct the fol- 
lowing key to the vision: During the previous even- 
ing I had been examining a number of East Indian 
photographs. Among the most remarkable of them 
was a picture of the glorious gardens of the Taj, at 
Agra. Another represented the ruined Buddhist 



134: INSOMNIA. 

tower at Sarnath, a structure remarkable for the nu- 
merous triangular figures carved as ornaments upon its 
sides. Hence the garden and the zigzag kite-string in 
the dream. During the day before, while conversing 
with a neighbor regarding the financial misfortunes of 
an acquaintance, I had remarked that if he had stopped 
kite-flying, and had settled down to legitimate busi- 
ness at last, he would doubtless do well in the future. 
Hence the kite. I had recently received an interest- 
ing letter from my literary friend in which he had 
mentioned my brother. Hence the two principal 
actors of the dream. Just before retiring, that night, 
I had discussed with my wife the subject of subscrib- 
ing for a number of periodical magazines. Hence the 
Atlantic Monthly; and, as the celebrated Oliver Wen- 
dell Holmes was the author most intimately associated 
in my mind with that periodical, his introduction 
among the characters of the dream followed most 
naturally in accordance with the law of the association 
of ideas. 

The question is continually asked, why are certain 
dreams so vivid and so easily remembered, while others 
are of the faintest and most evanescent character ? My 
own experience leads me to believe that there is a mor- 
bid element underlying all unusually vivid dreams. It 
is not merely because of differences in the depth of 
sleep. The flitting fancies which occupy the intro- 
duction and the termination of sleep, rarely possess 
any power to fix the attention or to linger in memory. 
But, if the body be disturbed by anything which 
causes a departure from the even course of health, 
such as follows unusual or violent emotion, or an attack 



DREAMS. 135 

of illness, or an insufficient alimentation, or great and 
sudden changes of atmospheric pressure, the visions of 
the night become wonderfully exaggerated in every 
particular. During a voyage at sea, while suffering 
considerably with thirst, one night I dreamed that a 
fountain of sparkling water suddenly appeared before 
me. A young girl dipped a pitcher in the flowing 
stream, and held it out. all dripping with delicious 
coolness, for me to drink. Pressing eagerly forward, 
I awoke, to find myself sitting up in my narrow berth, 
with hands extended for the draught. Every narrative 
of shipwreck is tilled with similar experiences. Slow 
starvation is always accompanied by dreams of singu- 
lar intensity and persistence. As an illustration of the 
corresponding influence of previous emotion, I may 
cite the experience of a friend who had been greatly 
shocked by reading the account of the manner in 
which the lunatic, Freeman, had killed his little son in 
imitation of Abraham's contemplated sacrifice of 
Isaac. This gentleman dreamed that he was about to 
sacrifice his favorite daughter. He called her to him; 
told her that he was about to cut off her head as a 
religious sacrifice ; and took up the knife for that pur- 
pose. She exclaimed, ,k Oh, papa! I have never diso- 
beyed you yet ! " and extended her neck, to receive the 
fatal stroke, when he awoke, trembling in every limb, 
and drenched with perspiration. For a long time the 
horror of this dream affected him as terribly as if it 
had been an actual experience. 

It is usually difficult to arrive at any exact estimate 
of the time occupied by a dream; but it appears cer- 
tain that in some instances the succession of images 



136 INSOMNIA. 

excited during sleep must be exceedingly rapid. Aber- 
crombie, in his work on the " Intellectual Powers and 
the Investigation of Truth" p. 275, has related several 
illustrative examples of this fact. In my own experi- 
ence, one night, as I lay half asleep, I heard the watch- 
man on his round, as usual, examining the fastenings 
of my front door. At once I began to dream that I 
was revisiting my father's house, the home of my child- 
hood. The family were at breakfast in the front par- 
lor, while I walked through the back rooms, examin- 
ing the doors and the windows, and found it impossible 
to close and to fasten them. I then took a bath, dressed 
myself, and walked out into a large garden behind the 
house. It was filled with tropical trees, of which some 
were young. The old ones, which I recognized after an 
absence of thirty years, astonished me by their surprising 
luxuriance. A lovely, trailing convolvulus, in full bloom, 
attracted my admiration. After walking for some time 
I came upon a plum tree which was very small when I 
left home, and had now reached a height not exceed- 
ing twelve feet. This slow growth excited considera- 
ble surprise on my part. Returning to the house, I 
passed the day with my parents, and, at night, under- 
took to shut up the house, but could not fasten any of 
the doors or windows. This caused me great uneasi- 
ness, for there was a large gypsy camp not far from 
the east end of the building. My anxiety was pres- 
ently justified by a noise in the parlor. Hastening to 
the door, and looking into the room, I saw a large 
painting disappearing through a hole in the wall next 
to the encampment of thieves. I immediately cried 
out, to frighten away the robbers; and was awakened 



DREAMS. 137 

by my wife, shaking me, and asking what was the mat- 
ter, just in time to hear the watchman walking down 
the front steps, after the completion of the investiga- 
tion which had suggested my dream. 

Another experience may serve to illustrate the fact 
that dreams are greatly intensified by illness, and that 
their duration may be exceedingly brief. Suffering, 
one night, from an attack of intestinal colic, marked 
by a rapid succession of painful paroxysms, between 
which, however, I fell asleep without the aid of medi- 
cine, I dreamed in one of these snatches of slumber 
that I was walking with my brother on the road to the 
volcano of Kilauea. In my hand were four diamond 
shirt buttons. They were white, and were covered 
with fine asbestos wool. My brother's wife expressed 
serious doubts regarding their value; but I at once 
reminded her that the Emperor of China had given to 
the English Ambassador, for presentation to the 
Queen of England, a number of diamonds which were 
so rough and so cheap in appearance that the ambas- 
sador, who was also a marquis, could not suppress his 
contempt as he received the gift. But, when carried 
to London, and cut by the royal jewelers, their brill- 
iance had astonished everyone. I now desired to de- 
posit my diamonds with a jeweler, for safe-keeping. 
My brother recommended a house near the volcano, 
but I had seen another, a few squares further up the 
road, and accordingly resorted thither. Not finding 
any satisfactory evidence of business, I retraced my 
steps to the place first recommended. Entering the 
door, I found myself in a narrow room, with a long, 
low counter on one side. Behind this were several 



138 INSOMNIA. 

men, and several cases filled with jewelry. I handed 
my buttons to a large, good-looking fellow, who was 
bustling around in his shirt-sleeves. He immediately 
put one of the jewels into his mouth, when I heard 
something crack, as if either his teeth or the diamond 
had split. Consoling myself with the recollection that. 
if broken, a diamond could be mended with cement, I 
asked for a certificate of deposit. "While this was be- 
ing written, the entire building slipped away from over 
us, and glided down the slope of the mountain, towards 
the ocean, leaving us, and all that had been within the 
house, uncovered in the open air. This did not discon- 
cert any one. The jeweler finished his writing ; I 
pocketed the receipt, and with my brother pursued our 
walk through the mountain forests beyond the crater 
of the volcano. Presently we arrived at an eminence 
from which we could look down upon the ocean, and 
could see the line of the coast prolonged for many 
miles on either side of a cape of land. The western 
coast was very grand — mountain promontories rising 
behind each other as far as the eye could reach. Hav- 
ing feasted our eyes with this magnificent panorama of 
earth and sea and sky, we turned away in the direction 
of a grove, in which was visible a large building of 
stone, with castellated walls, and turrets with pointed 
roofs at the corners. My brother informed me that 
this was a German settlement, called Little Clacius. 
Approaching the castle, we were received in a mag- 
nificent hall by a beautiful woman who offered to con- 
duct us through the building. She led us through a 
series of lofty rooms, splendidly painted, gilded, fres- 
coed, and furnished with inlaid tables and polished 



DREAMS. 139 

chairs. On either side were ranged large vases, in 
which grew what I seemed instinctively to recognize 
by the name of the Lace Mimosa — each plant consist- 
ing of a flat sheet of green lace-work, like a coralline, 
studded with lovely pale yellow blossoms. Passing 
through three such rooms, we entered a fourth, across 
the floor of which our fair guide whirled herself with 
a pirouette into the presence of a young woman clad 
in a richly figured dressing-gown, drawn lightly around 
her form as she sat in an easy chair, nursing her baby. 
We were formally introduced to this lady, who received 
us with the most evident indifference, a circumstance 
which gave us no concern, for the view from the open 
window at once engrossed my attention. Directly be- 
fore me was a shining river, pouring down the moun- 
tain side and falling about fifteen feet into a deep dark 
pool that widened beneath the window from which I 
gazed. High banks, covered with magnificent trees, 
sloped down into the water, and cast their shadows 
across its rippling surface, forming a most charming 
landscape. The breadth of the scene, the depth of the 
coloring, the perfection and the multiplicity of all the 
details that pressed upon the attention, could not have 
been surpassed in vividness by any real existence. I 
was admiring the view, and was beginning to feel sur- 
prised that so large a river could exist in such a place, 
when I was suddenly awakened by a renewal of the 
intermittent pain. 

In this example each individual detail could have 
been easily traced to its source in memory. Pictures, 
and actually existent scenery furnished the detached 
items which were combined in a brain that for the time 



14:0 INSOMNIA. 

being was released from the control of the reason and 
the will. Irritated by painful sensations the brain was 
inordinately excitable, and sleep was less profound. 
Hence the remarkable intensity of the pictures which 
were presented to the eye of the mind. The inde- 
scribable richness and variety of the vision was prob- 
ably due to the fact of extensive bodily disturbance, 
opening a wide range of territory from which impres- 
sions were communicated to the morbidly sensitive 
brain. The unusual permanence of the whole dream 
in memory may be explained by the observation of 
Maury, that the ease with which dreams are recollected 
varies inversely with the depth of the sleep in which 
they occur. Dreams which are produced in sound 
sleep are seldom recalled after waking, because they 
are but slightly connected with impressions received 
by the brain during wakefulness. ' But dreams which 
occupy the mind when sleep is light and partial are 
excited by cerebral movements which are closely asso- 
ciated with external impressions that originate either 
at the moment of awaking or immediately after that 
event; consequently, the bond of union between the 
ideas of the dream and our waking ideas is nearly if 
not quite as perfect as the bonds which serve to con- 
nect the thoughts that occupy any portion of our con- 
scious life. Hence such dreams are more easily 
reproduced from memory by any disposition that 
arouses a retrograde association of ideas. 

The dream above related, though excited by an un- 
healthy condition of the body, was not at all disagree- 
able. But it is often the case that disorders of 

l A. Maury, Le Somtneil et les Reves., p. 219 et seq. 



DREAMS. 141 

particular organs serve to originate visions with special 
and evident characteristics related to their source. 
Thus, one of my patients, during an attack of uterine 
and hemorrhoidal congestion, would dream that a 
heavy weight had been laid upon the lower part of the 
abdomen. On another occasion, having gone to sleep, 
apparently in perfect health, she dreamed of a terrible 
pain in the head, and that her husband and a physician 
were applying a cupping glass to the back of her neck. 
This woke her up, and she found that she was actually 
suffering with a very severe headache. Another lady, 
shortly after confinement, dreamed that her baby had 
teeth, and that it was biting her nipple. Next day she 
discovered a tender spot in the breast, which rapidly 
developed a mammary abscess. Forbes Winslow ' has 
collected a considerable number of similar cases. In 
certain instances not only have dreams been originated 
by special local pain, but the incipient stages of in- 
sanity have been revealed by exaggerated dreams. One 
of my patients, for a considerable time before the 
evolution of an attack of melancholia, would dream, 
every night, that a big black dog came into her bed. 
Another, who suffered with cardiac palpitation, caused 
by excessive tea-drinking, was often visited in sleep by 
a mocking imp who seated himself upon the pit of her 
stomach, and pressed her ribs together with his hands. 
The distress or alarm which accompanies such 
dreams is sometimes sufficient to arouse the sleeper. 
Often, however, he strives, in his vision, to escape 
from some impending horror, or to lift up his voice in 

1 Obscure Diseases of the Brain and Mind. Philadelphia, 1866, pp. 
394-398. 



142 INSOMNIA. 

a cry for help, but the will is powerless to reach the 
necessary muscles, and no movement results. In such 
cases the portion of the brain in which the will resides 
is awake, but the conducting fibres which intervene 
between the cortex of the brain and the locomotive 
ganglia in the cerebro-spinal axis are asleep, and can- 
not be sufficiently aroused to transmit the impulses 
derived from the action of the will. 

In all ages of the world a belief in the prophetic 
character of certain dreams has prevailed. Numerous 
examples are recorded in which a warning intimation 
of approaching disaster has been thus received. Thus 
the holy evangelist, St. Matthew, relates that Joseph, 
the husband of Mary, was guided by dreams to escape 
with his family from the murderous designs of Herod 
and of his son Archelaus. The literature of the mid- 
dle ages is filled with similar narratives. Coming 
down to recent times, it is not difficult to gather nu- 
merous examples of dreams which have been excited 
by presentiments of good or evil. A lady who was 
about to embark upon the ill-fated steamer Arctic, 
dreamed so vividly of shipwreck that she refused to 
take passage, and thus escaped the frightful disaster 
which overwhelmed the ship and its numerous passen- 
gers. Max Simon 1 relates the case of a lady who, in 
spite of a similar warning, embarked upon a steamship 
and lost her life, through the explosion of the boiler 
during the voyage. On another occasion 2 a noble lady 
dreamed that a wing of the palace in which her chil- 
dren were sleeping was about to fall down. Starting 

1 Lc Monde des Jeeves, p. 88. 

2 Op. cit., p. gi. 



PROPHETIC DREAMS 143 

up, she called her waiting ruaicls, and insisted that they 
should bring the children to her chamber. The women 
endeavored to calm her agitation, quoting an old 
proverb to the effect that " dreams go by contraries." 
As she persisted in her commands, they feigned obedi- 
ence, but soon returned to say that the young princes 
were sleeping too quietly to be removed. The princess 
would not be thus composed ; and at last Jie servants 
reluctantly brought the little boys from their room. 
They had scarcely reached their mother's apartments, 
when the disaster of which she had dreamed was real- 
ized, and the bedroom from which they had just been 
carried, was crushed into a mass of ruins. 

The ancient explanation of such events consisted in 
a reference to the Deity, who was supposed to address 
his favorites through the medium of dreams. The 
modern skeptical explanation views all such revelations 
as mere accidents. Among the myriads of dreamers, 
say the " five-sense philosophers," the infinite variety 
of combinations which disturb the brain during sleep, 
cannot fail to produce occasionally such coincidences. 
When these are of a striking character, the seemingly 
prophetic vision is remembered, but the cases of dis- 
crepancies between vision and result are not recorded, 
and are soon forgotten. This opinion may very prob- 
ably be correct in the vast majority of instances; but, if 
so, we are not in a position to assert any scientific 
demonstration of the fact. There is, moreover, so far 
as the ancient religious view is concerned, a certain 
transcendental sense in which it is true that God may 
guide his creatures through the agency of dreams, as 
well as in a thousand other different ways; but this 



144 INSOMNIA. 

metaphysical process we can no more comprehend than 
we can understand or explain the interaction of mind 
and matter in the brain. The psycho-physiologist 
must content himself, at present, with the attempt to 
show that it may not be incompatible with natural law 
for coming events to cast their shadows before them 
through the forms of a dream. The following obser- 
vations lend color to such a possibility. 

The extraordinary susceptibility of the brain during 
certain conditions of sleep has already been noted as a 
cause for the superior vividness of coloring and inten- 
sity of action which sometimes characterizes our 
dreams. In this respect a slightly morbid condition 
of the brain, comparable to the effects of hasheesh, 
probably exists. In such cases the brain may be dis- 
turbed to a degree sufficient for the awakening of con- 
sciousness by causes that would ordinarily be power- 
less to reveal themselves. Kecording his experience of 
an earthquake at Lesina, in the night of Sept. 8, 
1884, Buschick states, in the Journal of the Austrian 
Meteorological Society, that a few seconds before the 
shock he was awakened with a feeling of strange dis- 
comfort and apprehension. Once before, on a similar 
occasion, he had been in like manner aroused from 
sleep just before the commencement of an earthquake, 
probably by a feeble and ordinarily imperceptible agi- 
tation of the soil. At a time when I was for many 
months severely overtasked, I always woke up in the 
night whenever about to receive a call to a patient. 
Before the sound of footsteps became audible on the 
sidewalk, I would wake. Presently some one would 
be heard, approaching the house, and then the door- 



DREAMS. 145 

bell would ring. So often was this experience repeated, 
that I learned to expect a summons whenever awak- 
ened during the night. Gradually, however, as my 
health improved with rest, this morbid excitability dis- 
appeared, and has never been renewed. It seems prob- 
able that in this example the sensitiveness of the brain 
during sleep was so great that audible impressions 
were received with vigor sufficient to awake conscious- 
ness before they were sufficiently strong to arrest the 
attention when actually awake. The extreme sensibil- 
ity of the brain, under certain conditions, to impress- 
ions from a distance, is further illustrated by the expe- 
rience of persons laboring under diseases which 
produce serious departures from a healthy cerebral 
circulation. Thus, one of my patients, while suffering 
with cerebral hyperemia, could hear children talking 
half a mile away, at a distance where no one else could 
hear them. This susceptibility is doubtless the founda- 
tion of many well authenticated cases of presentiment. 
Another of my patients, a lady of remarkably sensitive 
nervous organization, though otherwise in apparently 
good health, was one evening lying alone upon her bed. 
Suddenly, she became greatly agitated with the convic- 
tion that something had happened to her husband, who 
had not yet returned from his place of business. He 
presently, however, came quietly into the house, and 
greeted his wife as usual. She exclaimed at once, 
"What has happened to you, my dear?" "Nothing," 
he replied. "Yes," she said, "something has hap- 
pened, just now; I felt that you were in trouble." "Oh, 
yes," answered he, after a moment's reflection, "as I 
was passing by the park, on my way home, two men 
10 



146 INSOMNIA. 

tried to stop my horse, but I whipped up, and got away 
from them without any trouble." 

On another occasion the same patient was one day 
suddenly oppressed by a conviction that something had 
happened to her mother and sister, who were driving 
together at some distance from home. After a 
short time they actually returned in a sorry plight, 
without their carriage. The horse had run away, up- 
setting them upon the road. 

In all these cases it is worthy of remark that there 
was present an unusual degree of cerebral erethism. 
Solicitude, weariness, anxiety, inordinate irritability of 
the brain. It is possible that under such conditions 
one may hear premonitory sounds, may in some sort 
feel distant agitations which our healthy organs are 
usually incapable of apprehending. When such a 
brain during sleep is unoccupied with the ordinary 
objects of sensation, feeble impulses, which usually 
remain unnoticed, may sometimes suffice to arrest the 
attention. We may thus explain the possibility of 
impressions derived from distant events passing into 
the consciousness of a dreamer, and arousing halluci- 
nations of which the immediate cerebral mechanism is 
the same as that of the ordinary hypnagogic halluci- 
nation. Thus, the Rev. Canon Warburton relates the 
following experience ' : 

" Somewhere about the year 1848 I went up from 
Oxford to stay a day or two with my brother. . . . 
When I got to his chambers I found a note on the 
table apologising for his absence, and saying that he 
had gone to a dance somewhere in the West End, and 

1 The Nineteenth Century, July, 1884, p. 71. 



CLAIRVOYANT DREAMS. 147 

intended to be home soon after one o'clock, Instead 
of going to bed, I dozed in an arm-chair, but started 
up wide awake exactly at one, ejaculating, ' By Jove, 
he's down!' and seeing him come out of a drawing- 
room into a brightly illuminated landing, catching his 
foot in the edge of the top stair, and falling headlong, 
just saving himself by his elbows and hands. (The 
house was one which I had never seen, nor did I know 
where it was.) Thinking very little of the matter, I 
fell a-doze again for half an hour, and was awakened 
by my brother suddenly coming in and saying, 'Oh, 
there you are! I have just had as narrow an escape 
of breaking my neck as I ever had in my life. Com- 
ing out of the ball-room, I caught my foot, and 
tumbled full length down the stairs.' " 

An incident of this character might very properly 
be ranked as a mere coincidence, were it not for the 
fact that it is one only of a considerable number of 
well attested acts of vision connected either with the 
hypnagogic state or with the act of dreaming itself. 
The comparative rarity of such events lends them a 
marvelous aspect; yet there is really nothing about 
them any more wonderful or preternatural than the 
demonstrated possibility of telegraphic signaling across 
the sea without the intervention of an electric wire. 1 
Under ordinary circumstances a metallic conductor 
must serve as the avenue of communication between 
distant stations ; but if a sufficiently sensitive piece of 
apparatus be placed in contact with the water on either 
side of an arm of the sea, communications may be 

1 Nature, October, 16, T8S4, p. 596. 



148 INSOMNIA. 

transmitted from one to the other by a diffusion of im- 
pulses through the entire body of water. 

In like manner we ordinarily see and hear and feel 
as a consequence of cerebral excitement occasioned by 
specific impressions concentrated through the organs 
of sight and hearing and touch. But it is quite reason- 
able to believe in the possible existence of a brain so 
delicately organized as to be capable of reacting to im- 
pressions which are too diffuse and too feeble to arouse 
the ordinary apparatus of sensation. With such a 
brain it might be possible to experience perception 
without eye-sight. Evidence furnished by the facts 
of somnambulism and hypnotism indicates that the 
receptivity of the brain may become temporarily ex- 
alted to a degree which warrants the inference that 
clairvoyance itself may be thus brought within the 
capacity of certain peculiarly sensitive organizations. 
The same extraordinary receptivity occasionally seems 
to attend the act of dreaming. For example, one of 
my acquaintances, a lady of a highly wrought nervous 
temperament, the wife of a distinguished physician in 
a neighboring State, dreamed one night that a favorite 
cousin, a beautiful little girl, who lived at a distance 
of twelve or fifteen miles, was very dangerously ill. 
She saw the child lying on its mother's lap, evidently 
at the point of death, when some one brought a tub of 
warm water and proceeded to give the patient a bath. 
This revived the little one so that she recovered. The 
dream made a very considerable impression upon my 
friend, by reason of its peculiar character, and because 
dreaming was for her a very unusual experience. Next 
morning she rose as usual, but during the forenoon 



CLAIRVOYANT DREAMS. 149 

she was startled by the receipt of a message request- 
ing her to come at once to the house of her uncle, as 
his little daughter had been taken suddenly ill with the 
croup, and had expired during the preceding night. 
Hastening to the bereaved household, she found her 
aunt sitting with the dead child on her lap, precisely 
as she had appeared in the dream. The little girl had 
been suddenly attacked during the night, and, as she 
lay gasping in her mother's arms, some one advised a 
warm bath, and brought a tub of water into the room 
for that purpose. Unfortunately, just as they were 
hopefully preparing to dip the child into the water, 
she had ceased to breathe. 

The lack of conformity between the conclusion of 
this dream and the actual fact reminds one of the 
blurring of the images that are transferred from one 
brain to another in the acts of telepathy recently in- 
vestigated by the Society for Psychical Research. 
Something similar is frequently observed in connec- 
tion with the phenomena of hypnotism. The hypno- 
tised subject does not always perceive clearly or wholly 
the sensation that is suggested by the agent who 
operates upon his brain. 

For another example of apparently clairvoyant 
dreaming, I am indebted to a friend, a well-known 
gentleman of unimpeachable veracity, who, when a 
young man in the army, during the war of the great 
rebellion, was taken very ill, and was sent home to 
New England from one of the most remote outposts of 
the campaign. No one of his family had the slightest 
information or suspicion of his illness, until the night 
before his arrival, when his father dreamed that the ab- 



150 INSOMNIA. 

sent son was sick, and would arrive the next day, at an 
hour unusual for travelers coming from the South. So 
vivid was this dream, and so powerful was its influence 
upon the mind of the dreamer, that he went at the 
specified hour to the railway station, with a carriage 
full of blankets and pillows, to receive his son. When 
the train arrived, and the invalid actually appeared, 
the mutual astonishment of father and son can better 
be imagined than described. 

In a recent work on hypnotism, 1 Fischer has related 
several personal experiences of a similar transfer of 
impressions during the waking state. It is highly 
probable that if such impressions are received by a 
sleeping brain, they may operate like other suggestive 
irritants to produce dreams, which may be sometimes 
so vigorously projected upon the consciousness of the 
dreamer that he may be awakened, and may still per- 
ceive the evolution of his dream as an hallucination, 
even after waking. Thus, on one occasion, during a 
malarial fever, I dreamed of seeing a friend who lived 
at a great distance. So vivid was the impression that 
I started up awake ; and there, at the foot of the bed. 
in broad daylight, was my friend, looking calmly at me. 
Several seconds, at least, were required to dissipate the 
vision. In an article already quoted, 2 Sir Edmund 
Hornby, late Chief Judge of the Supreme Consular 
Court of China and Japan, " who describes himself as 
' a lawyer by education, family, and tradition, wanting 
in imagination, and no believer in miracles,' " relates 

1 Lebensmagnetismus oder Hypnotismus , von Dr. E. L. Fischer, pp. 

71-73- 

2 The Nineteenth Century, July, 1884, p. 89. 



HALLUCINATIONS. 151 

his experience of a similar spectral visitation. After 
stating that "it was his habit at Shanghai to allow 
reporters to come to his house in the evening, to get 
his written judgment for the next day's paper," he 
says: 

" They generally availed themselves of the oppor- 
tunity, especially one reporter, who was also the editor 
of an evening paper. He was a peculiar man, reticent 
about himself, and I imagine had a history. In ap- 
pearance he was also peculiar. I only knew him as a 
reporter, and had no other relations with him. On the 
day when the event occurred, in 1875 or 1876, I went 
to my study an hour or two after dinner, and wrote out 
my judgment. It was then about half -past eleven. I 
rang for the butler, gave him the envelope, and told 
him to give it to the reporter who should call for it. 
I was in bed before twelve. I am a very light sleeper, 
and my wife a very heavy one. Indeed, it is difficult 
to rouse her out of her first sleep. The bed — a French 
one — faced the fire-place; on the mantel-piece was a 
clock, and the gas in the chandelier was turned down, 
but only so low as to admit of my seeing the time at 
any time of the night, for — waking easily and fre- 
quently — I often smoked a cigarette before I went to 
sleep again, and always desired to know the hour. 

"I had gone to sleep, when I was awakened by 
hearing a tap at the study door, but thinking it might 
be the butler — looking to see if the fire were safe and 
the gas turned off — I turned over with the view of 
getting to sleep again. Before I did so, I heard a 
tap at my bed-room door. Still thinking it might be 
the butler, who might have something to say, I said, 



152 INSOMNIA. 

'Come in.' The door opened, and, to my surprise, in 
walked Mr. . I sat up and said, ' You have mis- 
taken the door ; but the butler has the judgment, so go 
and get it.' Instead of leaving the room he came to 

the foot edge of the bed. I said, ' Mr. , you forget 

yourself! Have the goodness to walk out directly. 
This is rather an abuse of my favor.' He looked 
deadly pale, but was dressed in his usual dress, and 
was certainly quite sober, and said, ' I know that I am 
guilty of an unwarrantable intrusion, but finding that 
you were not in your study I have ventured to come 
here.' I was losing my temper, but something in the 
man's manner disinclined me to jump out of bed to 
eject him by force. So I said, simply, ' This is too 
bad, really; pray, leave the room at once.' Instead of 
doing so he put one hand on the foot-rail, and gently, 
and as if in pain, sat down on the foot of the bed. I 
glanced at the clock, and saw that it was about twenty 
minutes past one. I said, ' The butler has had the 
judgment since half -past eleven ; go and get it.' He said, 
' Pray forgive me ; if you knew all the circumstances, 
you would. Time presses. Pray give me a prScis of your 
judgment, and I will take a note in my book of it,' 
drawing his reporter's book out of his breast pocket. 
I said, ' I will do nothing of the kind. Go down stairs, 
find the butler, and don't disturb me — you will wake 
my wife — otherwise I shall have to put you out ?' He 
slightly moved his hand. I said, ' Who let you in ? ' 
He answered, ' No one.' ' Confound it,' I said, ' What 
the devil do you mean? Are you drunk?' He replied, 
' No, and never shall be again ; but I pray your lord- 
ship give me your decision, for my time is short' I 



EXPERIENCE OF SIR E HORNBY. 153 

said, * You don't seem to care about my time, and this 
is the last time I will ever allow a reporter in my 
house.' He stopped me short, saying, ' This is the last 
time I shall ever see you anywhere.' 

" Well, fearful that this commotion might arouse 
and frighten my wife, I shortly gave him the gist of 
my judgment in as few words as I could. He seemed 
to be taking it down in short-hand; it might have 
taken two or three minutes. When I finished, he rose, 
thanked me for excusing his intrusion and for the con- 
sideration I had always shown him and his colleagues, 
opened the door and went away. I looked at the 
clock; it was on the stroke of half -past one. 

( Lady Hornby now awoke, thinking she had 
heard talking; and her husband told her what had 
happened, and repeated the account when dressing 
next morning.) 

11 1 went to the court a little before ten. The usher 
came into my room to robe me, when he said, ' A sad 

thing happened last night, sir. Poor was found 

dead in his room.' I said, 'Bless my soul! dear me! 
What did he die of, and when ? ' ' Well, sir, it appears 
he went up to his room as usual at ten to work at his 
papers. His wife went up about twelve to ask him 
when he would be ready for bed. He said, " I have 
only the judge's judgment to get ready, and then I 
have finished." As he did not come, she went up again, 
about a quarter to one, to his room and peeped in, and 
thought she saw him writing, but she did not disturb 
him. At half-past one she again went to him and 
spoke to him at the door. As he did not answer she 
thought he had fallen asleep, so she went up to rouse 



154 INSOMNIA. 

him. To her horror he was dead. On the floor was 
his note book, which I have brought away. She sent 
for the doctor, who arrived a little after two, and said 
he had been dead, he concluded, about an hour.' I 
looked at the note book. There was the usual head- 
ing: 

" ' In the Supreme Court, before the Chief Judge. 
v. 

" * The Chief Judge gave judgment this morning in 
this case to the following effect' — and then followed a 
few lines of indecipherable shorthand. 

" I sent for the magistrate who would act as coro- 
ner, and desired him to examine Mr. 's wife and ser- 
vants as to whether Mr. had left his home, or could 

possibly have left it without their knowledge, between 
eleven and one on the previous night. The result of 
the inquest showed he died of some form of heart dis- 
ease, and had not, and could not have left the house 
without the knowledge of at least his wife, if not of his 
servants. Not wishing to air my 'spiritual experience' 
for the benefit of the press or the public, I kept the 
matter at the time to myself, only mentioning it to my 
Puisne Judge and to one or two friends ; but when I 
got home to tiffin I asked my wife to tell me as nearly 
as she could remember what I had said to her during 
the night, and I made a brief note of her replies and 
of the facts. 

" As I said then, so I say now — I was not asleep, 
but wide awake. After a lapse of nine years my 
memory is quite clear on the subject. I have not the 
least doubt, I saw the man — have not the least doubt 
that the conversation took place between us. 



EXPERIENCE OF SIR E. HORNBY. 155 

" I may add that I had examined the butler in the 
morning — who had given me back the MS. in the en- 
velope when I went to the conrt after breakfast — as to 
whether he had locked the door as usual, and if any one 
could have got in. He said that he had done every- 
thing as usual, adding that no one could have got in if 
even he had not locked the door, as there was no handle 
outside — which there was not. I examined the coolies 
and other servants, who all said they opened the door 
as usual that morning — turned the key and undid the 
chains, and I have no doubt they spoke the truth. The 
servants' apartments were separated from* the house, 
but communicated with it by the gallery at the back, 
some distance from the entrance hall. 

" The reporter's residence was about a mile and a 
quarter from where I lived, and his infirmities pre- 
vented him from walking any distance except slowly; 
in fact, he almost invariably drove. 

"Edmund Hornby." 

The publication of this remarkable story led to its 
correction in several important particulars. From the 
North China Herald (August, 1884) it appears that 
not only was Sir Edmund's memory defective in con- 
nection with several of the minor details of the narra- 
tive, but he had also been either wholly misinformed, 
or was quite forgetful regarding the actual time of the 
editor's death. That person was, in fact, alive and in 
his usual health at the time of his supposed apparition 
in the judge's chamber, and did not die till between 
eight and nine o'clock on the same morning. He had 
" attended a temperance committee meeting the night 
before, and had left about half -past ten in good health 



156 INSOMNIA. 

and excellent spirits. . . . He slept at home, rose 
shortly before eight, and visited his office to arrange 
some matter for that day's paper. He then returned 
to his room to dress, and in a few minutes afterward 
was found dead upon the floor." 

Between these conflicting witnesses it is of course 
impossible to decide. But for our purpose that is quite 
unnecessary. It is clear that Sir Edmund believed 
that the visible image of an acquaintance had appeared 
before him in his chamber at night. It is also evident 
that the judge was a man whose nerves had been dam- 
aged, probaftly by tobacco — for he was a "light sleeper" 
— waking often, and indulging in the luxury of a cigar- 
ette during the course of the night. If we may credit 
the writer in the Herald, his brain was in a process of 
deterioration, proved by the decidedly treacherous 
character of his memory. The whole story, therefore, 
becomes exceedingly instructive as an illustration of 
the manner in which a belief in apparitions may be 
originated. The most probable explanation of the in- 
cident is found in the hypothesis of a dream excited in 
an irritable brain that had been aroused by the prepa- 
ration of the manuscript which had occupied the 
thoughts of the judge immediately before retiring for 
the night. The course of this dream was so vivid that 
the sleeper awoke, but continued, like some other 
dreamers similarly awakened, to witness the evolution 
of his vision in the form of a genuine hallucination. 
A remarkable example of a similar production of hal- 
lucination through disease of the brain is related by 
the late Dr. E. H. Clarke. 1 One of his patients, a 

1 Visions: A Study of False Sight, p. 39. 



HALLUCINATIONS 157 

vigorous old gentleman, of eighty years, a great lover 
of music, and a frequent attendant at operas and con- 
certs, retired one night at the usual hour, and in his 
usual health. He soon fell asleep, " and slept well till 
about two a. M., when he was awakened by the sound 
of music, which seemed to come from the street near 
his house. Thinking a serenade was going on, he got 
up to ascertain where it was, but discovered nothing. 
The sound ceased when he arose. On returning to 
bed, he heard the sound of music again, and was at the 
same time surprised by the appearance of three per- 
sons, standing near each other in his chamber, opposite 
the foot of his bed. It was his habit to sleep with the 
gaslight burning feebly, near the head of his bed. He 
turned the gas on to its full power, and inspected the 
intruders. They appeared to be musicians, who were 
humming and singing, as if in preparation for a musi- 
cal performance. He rang a bell, which summoned his 
man servant. John soon arrived, and was ordered to 
put the strangers out. ' There is nobody here, sir,' 
was John's reply to the order. For a moment Mr. A. 
was not only amazed, but alarmed. ' What ! ' he ex- 
claimed, 'do you see no one there?' 'No one,' said 
John. 'Go where those chairs are, and move them,' 
was Mr. A.'s next direction. John did so. The 
strangers stepped aside, but did not go out. By this 
time Mr. A. had gathered his wits about him, and was 
satisfied that he was the victim of a hallucination; and 
he determined to observe its phenomena carefully. 
Accordingly, he bade his servant depart, and prepared 
to watch his visitors. But they were so life-like and 
human, that he was again staggered, and recalling 



158 INSOMNIA. 

John, told him to go for the house-keeper. She soon 
came, and on being interrogated, confirmed John's 
statements that there were no strangers in the chamber 
and no sounds to be heard. Convinced by the testi- 
mony of two witnesses, Mr. A. yielded to the decision 
of his reason, and again resolved to go on with the in- 
vestigation of the strange phenomena. The musicians 
had now resumed their position, near the window and 
opposite the foot of the bed. Mr. A. turned the light 
of the gas full upon them. He looked at his watch, 
which marked the hour of half -past two. He then ar- 
ranged his pillows, so as to sit almost upright in bed, 
and waited for the next scene of the play. He was 
able to note the size, form, dress, and faces of the per- 
formers. One was a large man, who bore some resem- 
blance to Brignoli. The two others were of less size, 
and shorter stature than their companions. All were 
habited in dress coats, with white waist coats, and wore 
white cravats and white gloves. After a little time 
spent in coughing and clearing their throats, they 
began to sing. They sang at first a few simple airs, 
' Sweet Home ' among others. They then attempted 
more difficult music, and gave selections from Beetho- 
ven and Mozart. Between the pieces they chatted with 
each other in a foreign language, which Mr. A. took to 
be Italian, but they did not address him. Occasionally 
they changed their position, turned in various direc- 
tions, and part of the time sat down. Mr. A. said the 
singing was excellent; he had rarely heard better. 
After the first feeling of surprise and amazement had 
passed away, he enjoyed the music exceedingly. The 
performance continued in this way for some time, when 



REVELATION. 15 ( J 

it suddenly came to an end. The singing ceased, and 
the singers vanished. He looked at his watch, and 
found that the time was four o'clock. The concert in 
his brain had lasted nearly an hour and a half, almost 
the length of an ordinary concert. He reflected for a 
while upon this strange occurrence, but not being able 
to arrive at any satisfactory explanation of it, he turned 
his gas down and went to sleep. The next morning he 
called at my office, as previously stated, to ascertain if 
possible what pranks his brain had been playing, and 
if he should regard them as warning of his approach- 
ing departure.' 1 

In this case the patient was suffering from " a mod- 
erate degree of deafness, persistent tinnitus aurium, 
occasional vertigo, and slight loss of memory." To- 
wards the close of life, two or three years later, "inco- 
herence, delirium, stupor, and the like, indicated with 
sufficient certainty the presence of severe cerebral dis- 
ease.' 1 The remarkable hallucination which he experi- 
enced was undoubtedly the product of the morbid 
changes which were progressing in his brain. 

These cases form an ascending series which illus- 
trates the receptive and constructive capacities of the 
human brain when its sensory apparatus has become 
unusually or morbidly excitable. But this preter- 
natural mobility may display itself in other depart- 
ments besides those of mere sense-perception. The 
sphere of pure intellect may thus be invaded by ideas 
springing from impressions which address the reason- 
ing faculties alone, so that in sleep a dream may lead 
the judgment to decisive conclusions that were scarcely 
recognized or heeded during the hours of wakefulness. 



160 INSOMNIA. 

In this way we may learn to understand how the 
anxieties experienced by the husband of the Virgin 
Mary may have ripened into a dream, of intensity 
sufficient to guide his subsequent action. Nothing 
could be more natural for one, like him, ignorant of 
physiology and of second causes in general, than the 
ascription of such an event to the immediate interven- 
tion of the Great First Cause — the only cause which 
he could rationally apprehend. Hence the universal 
primitive belief that in dreams God spake to man. 
Upon this belief was laid the foundation of many of 
the religious convictions which have grown and ripened 
with the progress of the race until their shadowy origin 
has been well nigh forgotten. 

Many are wont to affirm that the age of illumina- 
tion through the intervention of dreams is past, but 
there is no good reason for the belief that such dreams 
may not still occur. A lady, carefully educated in the 
doctrines of the popular theology, had been very much 
distressed by the unruly behavior of her only child, a 
little imp who had scarcely learned to talk. While 
thus depressed in spirits she dreamed that the Day of 
Judgment had come. She found herself with her hus- 
band and child and the whole human race assembled 
upon the face of the earth, waiting in agony for the 
awful decision of their fate. Finally the heavens were 
opened, and Jesus appeared, dividing the wicked from 
the good. As he drew near the place where she was 
standing, she could no longer endure her anxiety 
regarding the destiny of her daughter; she rushed 
forward, and implored the Divine Judge to spare her 
child. With a look of ineffable compassion he assured 



REVELATION. 161 

the trembling suppliant that her prayer was granted, 
and she awoke in a state of great agitation, but much 
comforted as to the future of her little girl, who in due 
course of time grew up to be a very exemplary young 
woman. Now, if the dream of Joseph was a revela- 
tion, a dream like this is quite as worthy of similar 
estimation. They both occurred as the result of analo- 
gous conditions of the brain and mind, and were both 
excited by second causes of a similar character. It is 
impossible for any one to show that the relation be- 
tween the First Cause and either set of second causes 
was any more intimate and special in one case than 
in the other. 

The wonderful exaltation of certain faculties during 
the unequal sleep of the different organs of the mind, 
is usually to be considered as something relative rather 
than absolute. But there is little reason to doubt that 
sometimes the excitement of the waking portions of 
the brain does really transcend the ordinary functional 
capacity of the structure. Under such conditions the 
undivided concentration of attention upon the compar- 
atively limited circle of ideas which are thus produced, 
greatly increases the intensity of the resulting impres- 
sions upon the mind in consciousness. Hence the 
grandeur of the visions which may thus arise ; hence, 
also, the possibility of their construction in accordance 
with fact rather than with fancy ; as in the case of the 
visions of the ancient Hebrew prophets. As the dark- 
ness of night, by shutting out the earth from sight, 
opens our eyes to the glory of the starry sky, so, in 
like manner, sleep, by closing the senses against the 
distractions of the external world, may sometimes 
11 



162 INSOMNIA. 

afford the conditions enabling a richly gifted intellect 
to comprehend the course and the destination of those 
deep and silent streams of thought which move on, 
unnoticed during the hours of wakeful life. 

Whatever may be true of this matter of fore-sight, 
it is certain that under similar conditions the memory 
of past events may be so quickened as to yield results 
quite comparable with actual clairvoyance. A good 
illustration of this has been recorded by Abercrombie. ' 
A gentleman named Rowland had been prosecuted for 
certain arrears of tithe which he believed had been 
long previously paid by his deceased father. " But, 
after an industrious search among his father's papers, 
an investigation of the public records, and a careful 
inquiry among all persons who had transacted law 
business for his father, no evidence could be discov- 
ered to support his defence. The period was now near 
at hand when he conceived the loss of his lawsuit to be 
inevitable, and he had formed his determination to ride 
to Edinburgh next day and make the best bargain he 
could in the way of compromise. He went to bed with 
this resolution, and, with all the circumstances of the 
case floating upon his mind, had a dream to the follow- 
ing purpose: His father, who had been many years 
dead, appeared to him, as he thought, and asked him 
why he was disturbed in his mind. In dreams men 
are not surprised at such apparitions. Mr. R. thought 
that he informed his father of the cause of his distress, 
adding that the payment of a considerable sum of 
money was the more unpleasant to him because he had 
a strong consciousness that it was not due, though he 

1 Inquiries concerning the Intellectual Powers^ tenth edition, p. 



REMINISCENCE. 163 

was unable to recover any evidence in support of his 
belief. ' You are right, my son,' replied the paternal 
shade; 'I did acquire right to these teinds, for pay- 
ment of which you are now prosecuted. The papers 
relating to the transaction are in the hands of 

Mr. , a writer (or attorney), who is now retired 

from professional business, and resides at Inveresk, 
near Edinburgh. He was a person whom I employed 
on that occasion for a particular reason, but who never, 
on any other occasion, transacted business on my 
account. It is very possible,' pursued the vision, ' that 

Mr. may have forgotten a matter which is now of 

a very old date: but you may call it to his recollection 
by this token — that when I came to pay his account 
there was difficulty in getting change for a Portugal 
piece of gold, and that we were forced to drink out the 
balance at a tavern. ' 

11 Mr. E. awoke in the morning with all the events 
of the vision impressed on his mind, and thought it 
worth while to ride across the country to Inveresk, 
instead of going to Edinburgh. When he came there 
he waited on the gentleman mentioned in the dream, a 
very old man; without saying anything of the vision, 
he inquired whether he remembered having conducted 
such a matter for his deceased father. The old gen- 
tleman could not at first bring the circumstance to his 
recollection, but, on mention of the Portugal piece of 
gold, the whole returned upon his memory; he made 
an immediate search for the papers and recovered them, 
so that Mr. K. carried to Edinburgh the documents 
necessary to gain the cause which he was on the verge 
of losing.' ' 



164 INSOMNIA. 

Here it would be a valuable addition to knowl- 
edge if the parties in the history just related could be 
subjected to intelligent interrogation. Enough, how- 
ever, may be discovered in the narrative to render it 
certain that the dream was merely a revival in con- 
sciousness of knowledge that had been long previously 
forgotten. There was a vague recollection of some 
such information evidently struggling for recognition ; 
otherwise Mr. E. could not have held the belief in spite 
of the lack of evidence, that his father had paid the 
tithes in dispute. He had probably heard from his 
father some account of a transaction which had taken 
place so long before that the only surviving actor, the 
aged lawyer, had forgotten everything about it, and 
could only recall the event through the associations con- 
nected with the Portugal piece of gold. In the law- 
yer's case the cerebral register only needed the stimu- 
lus afforded by the association of ideas, in order to 
make it again place before the mind impressions which 
had long subsided below the level of consciousness. 
For Mr. R., sleep afforded the limitation of cerebral func- 
tion needful for a concentration of attention sufficient to 
penetrate to the level of the residual vibrations which 
persisted as the sole representatives of the original 
impressions through which his knowledge of the event 
had been primitively obtained. Parallel examples are 
furnished by the cases of individuals who, upon their 
death-beds, during the dissolution of the brain, have 
resumed a long disused vocabulary, speaking the 
language and thinking the thoughts of their childhood. 
" He ' babbled of green fields,' " said Mistress Quickly, 
narrating the closing scenes in the life of the famous 



REMINISCENCE. 165 

Sir John Falstaff. Dr. Eush 1 relates the case of a 
learned Italian gentleman who, " in the beginning of 
the yellow fever which terminated his life, . . . 
spoke English only; in the middle of the disease, he 
spoke French only; but on the day of his death, he 
spoke only in the language of his native country." In 
like manner the old Swedish settlers in Philadelphia 
who had forgotten their native language, or, at least, 
had not spoken it for half a century, would pray in 
Swedish on their death-beds. 8 Sleep and dissolution 
operate alike to release the lower levels of the mne- 
monic apparatus from the overshadowing influence of 
later impressions, so that, like an ancient palimpsest, 
it presents once more its long-forgotten characters 
for inspection by the mind. 

1 Medical Inquiries and Observations upon Diseases of the Mind, 
p. 277. 

* Loc. cit. 



CHAPTEK VI. 



SOMNAMBULISM. 



A great perturbation in nature ! to receive at once the benefit of sleep, and do 
the effects of watching. —Macbeth. 

We have seen that in certain cases dreams manifest 
a tendency to pass into action. Thus, the dream with 
which I was on one occasion occupied became so amus- 
ing that I was awakened by a paroxysm of laughter 
that continued for some time after the termination of 
the dream. Sometimes the actions which are thus 
determined become more complicated, but do not suffice 
to arouse the sleeper. He continues to dream, and to 
act out his dream. This constitutes the ordinary form 
of somnambulism. It is a special affection of the nerv- 
ous system encountered chiefly among persons of a 
decidedly neurotic constitution — especially among the 
victims of hysteria, epilepsy, and insanity. Sometimes 
occurring in cases apparently characterized by perfect 
health, it will usually be discovered by careful inquiry 
that the subject is nevertheless connected by near rela- 
tionship with a neurotic stock. In a third class of 
patients the neuropathic diathesis is not congenital, but 
is the acquired result of particular injuries or diseases 
of the head. It is also observed sometimes as a conse- 
quence of transitory functional disturbances of the 
brain connected with the period of convalescence from 

(166) 



SOMNAMBULISM. 167 

diseases that profoundly affect the nutrition of the 
nervous system. In all cases, however, it is probable 
that a special nervous temperament exists as a predis- 
posing cause of the phenomena, for the majority of 
people can sustain injuries of the head, or of the peri- 
pheral nervous system, and can pass through all kinds 
of illness without exhibiting any tendency to somnam- 
bulism. As the nervous temperament is the peculiar 
property of children and of the female sex, it is among 
them that the affection is usually observed. Before 
the age of puberty, however, the differential peculiari- 
ties of sex are not sufficient to produce any great pre- 
ponderance in either direction; and small boys are, 
therefore, perhaps as frequently somnambulistic as 
their little sisters. Like other neuropathic disorders, 
this predisposition is frequently met with as an hered- 
itary attribute which may be handed down from gen- 
eration to generation. Occurring in the experience of 
young children, it frequently ceases when they arrive 
at years of maturity. Not always, however, thus ceas- 
ing as a consequence of improvement in the general 
health, but because of the substitution of some more 
serious disorder. 

The phenomena of ordinary somnambulism are 
manifested, like the dreams out of which they arise, 
during the period of sleep. But, while dreams most 
frequently occur during the later portion of the night, 
after the deepest sleep is past, somnambulism usually 
occurs in the earlier part of the night, during the deep- 
est sleep. As a consequence of this fact, conscious- 
ness is seldom affected by the molecular play of the 
brain during the somnambulic excursion. The sleep- 



168 INSOMNIA. 

walker knows nothing, and remembers nothing of the 
incidents in which he has been an active agent; while 
the dreamer seems to be more nearly awake. His 
consciousness is partially aroused by the play of 
memory and of imagination, and he can remember the 
spectacle which constituted his dream. The phe- 
nomena of somnambulism necessitate the participation 
of a larger number of faculties than are needed for 
the production of a dream, but their activities are 
coordinated upon a plane, so to speak, lower than the 
platform upon which the elements of dreams are 
arranged. Consequently, though the elements of the 
somnambulic process may be far more numerous and 
various than the elements of a dream, they may be less 
capable of rising into the realm of consciousness. Such 
a process may differ from the phenomena of ordinary 
life only in the fact of unconsciousness ; and, when con- 
cluded, it leaves no traces in the memory of the waking 
state. In other instances, on the contrary, so many 
nervous functions may be suppressed, and so great 
may be the intensity of the remaining cerebral pro- 
cesses, that the resulting phenomena scarcely differ 
from an ordinary dream in which consciousness is 
aroused, and the waking memory is durably impressed. 
Between these extremes lie opportunities for an indefi- 
nite number of combinations; consequently the forms 
and degrees of somnambulism present a very great 
variety of manifestation. Maury ' reduces these to five 
principal forms : First, simple movement of the limbs 
in connection with that partial sleep of the intellectual 
faculties which produces ordinary dreams. Second, 

1 Le Sommeil et ies Rives, p. 248. 



SOMNAMBULISM. 169 

somniation, a state in which the patient unconsciously 
performs such actions as have become so far habitual 
that, though complicated in their character, they con- 
stitute genuine cerebral reflexes. Third, noctambulism, 
or sleep-walking, in which the action, though compli- 
cated in its character, and different from the ordinary 
waking occupations of the patient, appears to be the 
result of automatic processes, constituting a dream that 
is acted out in time and space. Fourth, somnambulism 
with exaltation of the faculties, producing delirium 
with conscious movements during the crisis. Fifth, 
somnambulic life, or double consciousness, in which, 
with the exception of certain special modifications of 
intelligence, the conduct of the patient during the 
paroxysm does not perceptibly differ from that of the 
waking state, so that the subject seems to experience 
two successive though disconnected personalities. 

The exact relation between these different degrees 
of somnambulism has been further elucidated by MM. 
Ball and Chambard. 1 Starting with the proposition 
that normal healthy existence is a state in which the 
functions of organic life furnish a basis for nervous 
sensibility and motion, by means of which the imagina- 
tive faculties (imagination and memory), associated 
with the coordinative faculties (attention, judgment, 
volition), are sufficiently stimulated to maintain a state 
of consciousness, they show that the first stage of sleep 
consists in the suppression of bodily motion and sensi- 
bility. The second stage consists in the further sup- 
pression of the coordinative faculties. The third stage 
is marked by the loss of memory and imagination. In 

x Dic. Encyc. des Set. Af/d., Article Somnambulisms Naturel. 



170 INSOMNIA. 

the most profound and perfect sleep the functions of 
organic life alone remain. The process of awaking 
consists in the revival of the faculties in the inverse 
order of their extinction. Dreams occur during the 
period in which motion, sensation, and the coordinative 
faculties are in abeyance; but somnambulism may 
accompany each of the stages of sleep. Its simplest 
form is perhaps the rarest; corresponding to Maury's 
fifth variety. In this form the functions of organic 
life* are intact ; motion and sensibility seem unchanged ; 
the intellectual faculties display their usual activity; 
but the ordinary consciousness is never aroused. So 
far as the normal life of the subject is concerned, he is 
active, sensible, intelligent, but unconscious ; and when 
the paroxysm is terminated memory contains no 
account of its events. Such paroxysms may occur but 
once in the life-time of an individual, or they may be 
repeated at stated intervals, constituting an alternate 
succession of mental states without connection in con- 
sciousness. This is called the somnambulic life, or 
double consciousness, several examples of which will 
be related upon another page. 

The second form of somnambulism results from the 
abolition of consciousness and the more or less com- 
plete suppression of the coordinative faculties of the 
mind. Memory and imagination, released in great 
measure from the control of the higher intellectual 
faculties, and excited by such vestiges of sensation as 
still persist, create a species of delirium in which 
mutilated sensations, half formed thoughts and dispro- 
portioned volitions combine to produce a variety of 



SOMNAMBULISM. 171 

actions. In this condition the patient dreams, and acts 
out his dream. He is a somnambulic dreamer. 

In the third degree of somnambulism, conscious- 
ness and the entire range of intellectual faculties have 
disappeared. The individual resembles a creature 
from which the cerebral hemispheres have been 
removed. He is little better than a living automaton, 
guided only by impressions received from without. In 
this condition the movements of the body may become 
wholly responsive to the will of another— a prominent 
characteristic of artificial somnambulism or hypno- 
tism. 

A fourth degree of somnambulism is marked by the 
disappearance of consciousness, intellect, sensibility, 
and the power of motion. Only the lower functions of 
organic life remain. The patient merely lives, he 
neither thinks nor acts. This constitutes the state of 
somnambulic lethargy, a condition which differs from 
deep sleep only in the fact that under the influence of 
external impulses or of partial awaking it may easily 
pass into the second form of the affection, the som- 
nambulic dream. 

Such is the classification of MM. Ball and Cham- 
bard. It possesses the merit of great precision and 
clearness. If the warning which its authors them- 
selves utter against its too literal acceptance be 
respected, it will be found to afford a very convenient 
explanation of the manner in which the various degrees 
of somnambulism are reached. But it must be remem- 
bered that between these pronounced and definite forms 
exist a great number of intermediate degrees. Partial 
revivals and temporary resurrections of the higher 



172 



INSOMNIA. 



faculties of the mind may intrude themselves among 
the activities which depend upon lower functions; as, 
for example, when the ordinary unconsciousness of 
lethargy is briefly interrupted by an event which may 
remain permanently fixed in memory after waking, even 
though all other concurrent incidents were unnoticed 
and left no trace behind. Keeping this caution in 
mind, the following diagram will be found useful : 



1 


03 

13 

o 

1 

O 


tz a 

,qS3 
SO 

V 
02 


So 

S H 

« a 

I 1 . 

a *" 
"5a 
a 5 


03 » 

« c 

11- 

,==•0 a 
fe a o 

5 a "3 


OS 
EP 

a> 

a 

on 

a 
o 
o 

GO 

a 

6 
















































Somnambulic dream 
























Somnambulic automatism 
























- 













The close parallel between this diagram and the 
the one on page 4, which illustrates the course of 
sleep, will be at once remarked. The difference between 
the two states cannot be thus diagrammatically 
expressed. It is the difference between sleep in a 
healthy, normal subject, and sleep as modified by the 
somnambulistic temperament. This may be either the 
result of disease or of congenital defect of cerebral 
organization. What the particular structural differ- 



SOMNAMBULIC LETHARGY. 173 

ence may be, it must be impossible to decide, until it 
shall become possible to state the reason why one 
brain shall behave only in a normal manner, while 
another presents all the vagaries of hysteria, som- 
nambulism, — perhaps even of insanity. That the 
affection is hereditary is a matter of common observa- 
tion. One of my patients who is somnambulistic — 
walking in his sleep, climbing over the roof of his 
house, etc. — is the son of a father who was also a noc- 
tambulist, and who once fractured his leg by falling 
from a step as he was walking down stairs in his sleep. 
A grand-daughter is both a somniloquist and a som- 
nambulist. 

Returning now to the classification adopted by Ball 
and Chambard, it will be found interesting to consider 
a few illustrative examples of the different forms and 
degrees of the affection under consideration. 

Somnambulic Lethargy. — This condition represents 
the form which outwardly resembles profound sleep. 
It may occur as a paroxysm without relation to 
other forms of the affection, or, according to my own 
observation, more frequently associated with other 
forms of somnambulism. Thus, one of my patients, a 
lady about thirty-five years of age, having accident- 
ally fallen into the hands of a noted empiric, by whom, 
for a slight attack of tonsillitis, she was vigorously 
dosed with atropia, digitalis and calabar bean, finally 
passed into a somnambulic state corresponding to the 
somnambulic life of the preceding table. This con- 
tinued about five weeks, when she became completely 
lethargic, and was transferred to my care. In this 
condition she remained unconscious, almost perfectly 



174 INSOMNIA. 

insensible, with pupils somewhat contracted and slug- 
gish before the light, with a feeble and slightly accel- 
erated pulse, a moderately elevated temperature, bowels 
and bladder insensible to their contents, mouth and 
throat filled with an offensive mucous secretion. By 
great urgency she could be sufficiently roused to open 
her mouth, so as to permit cleansing the cavity, and to 
swallow liquid food. Swallowing was effected very 
slowly, and only after the liquid had remained for 
some time in the fauces. At the end of about three 
weeks the patient began to exhibit more vitality. She 
could be more easily aroused, began to dream and to 
have hallucinations that were finally prolonged out of 
sleep into wakefulness. In the course of a few hours 
she was fully herself again, after eight weeks of 
unconsciousness. 

This form of lethargy is characterized by the com- 
plete unconsciousness which persists during its course. 
Its duration is variable, sometimes continuing for a 
few minutes only; sometimes lasting through many 
days and weeks. Dr. "W. T. Gairdner, Professor of 
Medicine in the University of Glasgow, 1 reports the 
case of a woman who remained for over one hundred 
and sixty days in a condition of lethargic stupor. " The 
patient was the mother of a family, and had lived a 
strictly domestic and (up to a short time before her 
seizure) healthy and regular life. There were no 
peculiar moral and religious problems to perplex the 
situation. There was no history of inveterate hysteria, 
or of long continued rapt contemplation ; nor has there 
been the slightest evidence of any craving after noto- 

1 The Lancet, Dec. 22, 1883, p. 1,07s, and Jan. 5, 1884, p 5. 



SOMNAMBULIC LETFTARGY. 175 

riety, either before the attack or since its termination. 
The moral atmosphere, in short, surrounding the phe- 
nomena, is altogether unfavorable to exaggeration and 
imposture, for which, indeed, no reasonable motive can 
be assigned. Nevertheless, under these very common - 
place conditions, concurring with some degree of 
melancholy or mental despondency after delivery, 
but during a convalescence otherwise normal, Mrs. 
Mel presents to our notice a condition of sus- 
pended consciousnes's and disordered innervation in no 
degree less extreme than the 'trances' or cataleptic 
attacks which have been recorded as the result of the 
most aggravated hysteria, or as the miracles of relig- 
ious ecstasy and profound mental emotion. She be- 
comes for the long period of over one hundred and sixty 
days continuously an almost mindless automaton, con- 
nected with the external world only through a few 
insignificant reflexes and through the organic func- 
tions. She is fed, almost without resistance, through 
the stomach -tube; she defecates and urinates (during 
much the greater part of the time) unconsciously ; she is 
absolutely passive as regards everything that demands 
spontaneous movement, and betrays almost no sign of 
sensation, general or special, when subjected to the 
severest tests that can be applied short of physical 
injury. But while her senses were thus shut, and her 
volitions in suspense to an extent much beyond 
ordinary sleep, there was, nevertheless, a sleep within 
the sleep. The periodicity of day and night was 
maintained by some change in the condition of the 
innervation, of which snoring was the sole indication. 
She was not convulsed, nor paralyzed, nor delirious; 



176 INSOMNIA. 

the singing, laughing, weeping, adoring ecstasies of 
hysteria and of religious excitement were wholly want- 
ing; nor were there during many months such inter- 
vals of normal consciousness as are observed in almost 
all the recorded cases of hysterical coma and of cata- 
lepsy. The statue-like pose, moreover, and the flexi- 
bilitas cerea of typical catalepsy, are absent in this 
case. The return to consciousness was followed or 
accompanied by a return of all the normal functions of 
mind and body; there is now no incoherence, nor even 
distorted perceptions, as of a dream-life occupying the 
somnolent imagination for months, and therefore all 
the more hard to reconcile with realities. She is self- 
possessed, but unobtrusive, easily managed, and betray- 
ing only natural emotion; she persists in maintaining 
that the whole period of the apparent unconsciousness 
is a complete blank to her recollection. She is grate- 
ful for her recovery, but manifests no craving for sym- 
pathy, and no tendency, as yet, to revert to any morbid 
condition of despondency, such as was described at the 
commencement of the attack. In connection with this 
last point, although there is no evidence of her having 
been personally insane, it is not to be denied that her 
family history contains strong presumptions of a hered- 
itary predisposition bearing in that direction." 

These cases must not be confounded with the 
examples of lucid lethargy, to which allusion has been 
made in a previous chapter. Somnambulic lethargy 
is a condition in which the cerebrum is wholly inert. 
In lucid lethargy, although there is complete loss of 
general sensibility and of the power of voluntary 
motion, the field of consciousness is continually 



SOMNAMBULISM. 177 

enlightened by perceptions derived from one or more 
of the special senses, so that the subject is conscious 
of much that transpires in his immediate neighbor- 
hood. These two forms of lethargy sometimes alter- 
nate in the experience of the same individual, consti- 
tuting a portion of the indefinitely varied manifestations 
of hystero-epilepsy. Grasset relates the case 1 of a little 
girl, ten years old, who suffered with various forms of 
hysteria, which were finally replaced by attacks of 
stupor, lasting several hours. After a time these crises 
of " nervous sleep " were transformed into more ordin- 
ary attacks of somnambulism, in which, " although the 
child's eyes are shut, she sees and hears everything 
during the crises, knows who comes into the room by 
their step and walk. If anything unpleasant is said to 
her, or if they threaten to wet her, or make her smell 
something, she gets angry, and pushes everything 
violently away that is offered to her. She replies by 
signs to all questions, and if she wants anything, 
asks for it by gesture: if she wants to drink, she 
puts her finger to her lips as if in the act of suck- 
ing, and if not understood, becomes irritated, gets up, 
and leads the father or mother to the sideboard or 
cupboard, where the things she wants are, and always 
with the eyes shut. She is able to go through the 
whole house, I do not say quite alone, because they do 
not allow her to walk alone, but with help, and she 
directs the way wherever she wishes to go. During 
the crises she even sometimes amuses herself with a 
little dog, which she makes jump over a stick resting 
on the cross-bars of two chairs opposite each other; 

x Brain, Jan., 1884, p. 454. 
12 



178 INSOMNIA. 

and according as she wishes the dog to jump higher or 
lower, she moves the stick to the lower or higher bars 
of the chairs, and that with eyes always shut spasmod- 
ically. During the whole attack she cannot talk; but 
towards the end she speaks, although not yet recovered 
from her state of somnambulism. When the crisis is 
over, the child remembers nothing of what she has said 
or done in her sleep, and is much surprised at every- 
thing told her." 

Somnambulic Dreams. — The preceding cases illus- 
trate the variable character of the manifestations of 
somnambulism, and may also serve as an introduction 
to the more common form of the affection, in which the 
patient experiences a dream, probably excited by the 
same causes that produce ordinary dreams, and also 
acts out his dream. The differences between an 
ordinary dream and a somnambulic dream lie in the 
fact that the one produces an often vivid impression 
upon consciousness and memory, while the other is 
entirely expended upon the organs of external expres- 
sion. Starting probably from the same portion of the 
brain, the physiological dreara sets in motion the cor- 
tical structures which are in immediate relation with 
conscious memory; the impulses of the somnambulic 
dream, on the contrary, are directed towards the lower 
portions of the nervous system, where they serve to 
excite the organs of locomotion and expression, which 
are destitute of every form of mnemonic register. Con- 
sequently, the somnambulist retains no recollection of 
the incidents of his dream. 

The simplest form of this affection is presented by 
the restless child who talks, cries out, and brandishes 



NIGHT TERRORS. 179 

its fists in sleep. In the majority of instances these 
manifestations create little more disturbance than the 
half uttered yelping of a dog that barks in its sleep. 
But in some cases the outbreak assumes a distressing, 
if not an alarming character, constituting the affection 
known by the name of night terrors. The disorder is 
usually observed in young children of a highly nerv- 
ous temperament, before the conclusion of their second 
dentition. The little patients are generally of neurotic 
lineage. Insanity, hysteria, neurasthenia, epilepsy, 
chorea, and nervous dyspepsia, are often discovered 
among their near relatives. Not unfrequently they 
have been, or will become, choreic. The attack is 
often preceded by symptoms of indigestion and con- 
stipation; bat the exciting cause maybe usually traced 
in the commotion of a brain that has been wearied by 
the exertions of the previous day. The child starts up 
out of an apparently sound sleep, crying with seeming 
alarm, calling for his mother, and staring wildly 
around, with every possible expression of terror. Some- 
times he jumps from his couch, and runs headlong into 
a corner, or seeks concealment under the bed, as if 
escaping from "some frightful object. The eyes are 
open, tears flow, perspiration covers the skin, there is 
the greatest excitement, and the little one, clinging 
convulsively to its parent, will not be quieted. Only 
after a number of minutes does the child seem to 
recover the power of recognizing his friends. Presently, 
however, he lies down, and falls immediately asleep, 
waking in the morning without the slightest remem- 
brance of the unpleasant event. 

Such paroxysms occur during the early part of the 



180 INSOMNIA. 

night, one or two hours after bedtime, when sleep is 
passing from its maximum intensity to an inferior 
degree of depth. This, moreover, is the time when 
the controlling power of the sensory apparatus over 
other portions of the nervous system has already 
reached its minimum. The spinal centres and those 
intra-cranial ganglia which do not share in the full 
measure of this repose are therefore in a condition of 
relative exaltation. Disturbances of internal origin, 
consequently, produce inordinate excitement of these 
waking portions of the nervous apparatus. The 
abnormal quality of this excitement is attested both 
by the history of the patient, and by the fact that it 
does not pervade the whole brain. The distribution of 
motion through the cerebrum is hindered, so that cer- 
tain portions of the organ remain asleep while other 
regions are thrown into a state of tumultuous uproar. 
Such disconnection of the different organs of the 
nervous system, by withdrawing particular ganglia 
from the inhibitory influence of the other centres, 
gives opportunity for violent explosions of nervous 
force. 

Somewhat similar in their origin a*re those acts of 
unconscious violence which sometimes occur during 
the process of sudden awakening out of sound sleep. 
The patient is usually a deep but uneasy sleeper, who 
is only aroused imperfectly and with difficulty tfhen 
the attempt to awaken him is made. Under such 
circumstances the disturbance to which he is subjected 
serves as the exciting cause of a dream which, like the 
ordinary somnambulist, he puts into action before he 
is fully waked. On recovering complete consciousness, 



SLEEP - DRUNKENNESS. 181 

he may retain no recollection of the events of his 
dream, and may also experience as great a degree of 
astonishment at the results of his violence as if he had 
taken no part in its display. A gentleman of my 
acquaintance, who had suffered considerable uneasi- 
ness regarding burglars, was, one night, startled by a 
noise in his room. Jumping up suddenly, he grasped 
a pistol and fired it in the direction of a figure dimly 
perceived near the bed. On waking fully out of sleep, 
he found that he had inflicted a wound upon the hand 
of his wife whose movements had disturbed him. 
Another unfortunate, who was once under my observa- 
tion for undoubted insanity, was in like manner aroused 
out of sleep by a supposed noise, probably heard in a 
dream. With a pistol in each hand, he commenced 
firing wildly in every direction, fatally wounding his 
wife who was in bed at his side. When completely 
awakened he had no recollection of what had occurred, 
and was overwhelmed by the event. 

Wharton and Stills ' have collected a number of 
similar examples of this disorder, to which the term 
somnolentia or sleep-drunkenness has been applied. Its 
connection with morbid disturbance of the brain is 
usually very evident. Obviously, the moral responsi- 
bility of the agent in such cases is identical with that 
of the ordinary somnambulist, or of the subject of 
epileptic mania. 

Ordinarily, however, the somnambulic dream is less 
agitated. The patient merely continues the move- 
ments with which he was occupied at the moment of 
falling asleep, as in the case of Galen, who, though 

x Medical Jurisprudence, 3d ed., Vol. I, pp. 464-471. 



182 INSOMNIA. 

long an unbeliever of the tales regarding sleepy- 
soldiers who had unconsciously continued to march 
with their comrades, at last found himself in a similar 
manner walking a considerable distance after he had 
been overtaken by sleep while journeying on foot. In 
other cases the phenomena though intimately con- 
nected with the daily occupations of the subject, 
present themselves in a form somewhat detached from 
the waking life. Such are the common experiences of 
children who get out of bed, and walk around the 
house, seeking their playthings, or pulling their clothes 
out of the drawers in which they have been laid. Some- 
times the events of the day have evidently suggested 
the deeds of the night. One of my little acquaint- 
ances will leave her bed, walk into another room, seat 
herself by her mother's work-basket, thread a needle, 
and proceed to sew up the imaginary holes in her dress. 
One of my early playmates, in like manner, after puz- 
zling over a difficult sum in arithmetic, before retiring, 
arose in his sleep, took paper and a pencil from his 
mother's desk, and proceeded before her eyes to work 
out the correct answer. Another, tempted probably 
by a vision of ripe grapes upon the trellis, climbed out 
of his window upon the roof of a shed. Unfortunately, 
the certainty with which somnambulists usually direct 
their movements seemed to fail him. He fell heavily 
to the ground, where he awoke to find himself seriously 
injured. 

An excellent example of a still more complicated 
series of actions during somnambulism is quoted by P. 
Max Simon. 1 It illustrates a majority of the facts 

1 Le Monde des Reves, p. 257. 



SOMNAMBULISM. 183 

which have been already brought forward, and will 
well reward careful consideration. " A young clergy- 
man was in the habit of getting up in his sleep, taking 
paper, composing and writing sermons. When he had 
finished a page, he would read it over, if an action 
performed without the assistance of sight can be called 
reading. If dissatisfied with anything, he would blot 
it out, and then write the corrections with great accu- 
racy in their appropriate place above the line. In one 
of these sermons he made a correction which was quite 
remarkable. Having in one place written the words 
cc divin enfant, on revising the page he decided to 
substitute the word adorable instead of the word divin. 
He therefore blotted out this last word and placed the 
other immediately over it; then, perceiving the word 
ce, which was proper enough before the word divin, 
lacked the terminal letter / that was needed before a 
vowel, he very adroitly added the necessary letter, so 
that the amended sentence correctly read cet adorable 
enfant. In order to ascertain whether the somnam- 
bulist made any use of his eyes, a cardboard was placed 
under his chin in such a way as to completely obstruct 
the view of the paper upon the table ; but he continued 
to write without paying any attention to the obstacle. 
In order to ascertain whether he was aware of the 
presence of the objects which were before his eyes, the 
paper upon which he was writing was taken away, and 
a number of other sheets were successively slipped into 
its place; but he always noticed the substitution, 
because they differed in size. When an exactly simi- 
lar piece was substituted, he accepted it as his own, 
and wrote down the corrections at the points which 



184 INSOMNIA. 

corresponded exactly with the writing upon the page 
which had been removed. It was by means of this 
ingenious stratagem that some of his nocturnal com- 
positions were preserved. 

" The most astonishing thing of all," continues the 
author of this article, "was the exact composition of 
music. A cane served him as a ruler. With it he 
ruled at equal distances the five necessary lines, putting 
in their proper place the clef, the flats and the sharps. 
Finally, he inscribed the notes, at first all in outline, 
but, when he had finished, he blackened those which 
should be dark. The words of the song were written 
below. On one occasion he happened to write them 
with too large a hand, so that they were not placed 
directly under their corresponding notes. He soon 
perceived this defect, and, in order to amend it, he 
blotted out what he had done by drawing his hand over 
it, and then rewrote the line of music lower down the 
page with all the precision imaginable. 

"Another singular thing of a different sort, which 
was not less remarkable. One night, in the middle of 
winter, he dreamed that he was walking on the bank of 
a river, and saw a child fall into the water where he 
was drowning. The severity of the cold did not hinder 
him from hurrying to the rescue. He threw himself at 
full length upon his bed, in the position of a man who 
is swimming, and imitated all his movements. After 
having fatigued himself for some time with this exer- 
cise, he felt a portion of the coverlid gathered in a 
heap on one corner of the bed. He believed this to be 
the child; grasped it in one hand, and with the other 
went through the motions of swimming back to the 



SOMNAMBULISM. 185 

bank of the supposed river. There he laid down his 
burden, and came out, shivering and chattering 
his teeth as if he were really getting out of an icy- 
river. To the bystanders he said that he was freezing, 
and would die of cold, that his blood was all turned to 
ice ; he must have a glass of brandy to warm him. Not 
having any, they gave him some water which chanced 
to be in the room; he tasted it, recognized the decep- 
tion, and called, with greater emphasis than before, for 
brandy, insisting upon the magnitude of the danger 
which threatened his health. A glass of liquor was 
finally given to him; he drank it with pleasure, and 
spoke of the great relief which it afforded him. Not- 
withstanding all these incidents, he did not wake, but 
went to bed, and slept most profoundly." 

An equally instructive case is related by my dis- 
tinguished colleague, Prof. J. Adams Allen. 1 The 
subject of the observation was a medical student who 
resided in Professor Allen's house during a portion of 
the time covered by the narrative. 

" About the summer of 1847, a somewhat dilapi- 
dated bass-viol, which was a kind of heir-loom in the 
family, was brought into the house, and he devoted 
spare moments to learning how to play upon it. 
Unfortunately, the antiquity of the instrument had 
told upon its keys, and unless they were wetted at each 
time of use, it would not remain in tune. He was 
determined, however, to command its notes, and suc- 
ceeded. His somnambulic walks, thereafter, led him 
from his chamber to the parlor, and to the bass-viol, 
and the family would be awakened in the small hours 

1 Chicago Medical Journal, i86g, p. 650. 



186 INSOMNIA. 

by the inevitable tuning up prelude, mingled with 
slipping of the old keys, and quiet objurgations upon 
his part. Sometimes the bridge would fall down when 
the keys slipped, and sometimes a string would snap 
or escape from the keys, nevertheless he would perse- 
vere, repair damages, tune up, and then execute all 
varieties of music of which the machine was capable, 
not unfrequently accompanying it with his voice. All 
this would be done in total darkness. When any one 
entered the room with a light, he took not the least 
notice, although when spoken to he would reply in 
monosyllables or with considerable asperity. His face 
was usually flushed, although sometimes pale — the 
features immobile and passive, the eye open, pupil 
dilated, the surface glazed, and the lids apparently 
motionless. The extremities warm and the pulse full, 
frequent and soft. Very often the skin would be 
bathed with free perspiration. Remarkably sensitive 
to titillations when awake, there seemed total absence 
of reflex movements from this cause whilst in the som- 
nambulic state. 

"As he extended his acquaintance with music and 
musical instruments, his feats became wonderful. 
Whilst in attendance upon the Medical College at La 
Porte, the household looked forward with high antici- 
pations to the hours when his skillful touch of the 
melodeon would wake them. He had a voice of the 
purest tone and very considerable compass, in fact of 
rare sweetness. I am enabled to say from a multitude 
of observations, that he played with a precision and 
skill while asleep that he could not approximate while 
awake. Besides this, he would execute music which he 



SOMNAMBULISM. 187 

had heard, perhaps, but once, the evening previous or 
after a long interval — no note of which he could recall 
in his waking moments. His memory here seemed 
wonderfully exalted. If interrupted, he was irritable 
in the extreme, but would go on with his music exactly 
from the point of interruption. 

••Among the numberless exhibitions of his som- 
nambulism, I have time only to notice a few of the 
most striking. 

" Whilst attending lectures at Ann Arbor, where I 
was then lecturing on Physiology, I requested his 
assistance in enlarging some of the drawings illustra- 
tive of minute anatomy and histology, for use in class 
demonstrations. He entered into the work with great 
zeal, and proved very expert and rapid in execution. 
One evening, previous to the day on which I was about 
to lecture on the kidney, I wished the cuts in Carpen- 
ter's Physiology, illustrating the tubular arrangement, 
etc., were ready. He had an engagement for the even- 
ing, but said he would try and prepare them in the 
morning. During the night he rose, dressed himself, 
played a few tunes on the guitar, part of the time sing- 
ing (and, by the way, the guitar was about as dilapi- 
dated as the bass-viol before noticed, and he had to 
knot one or two of the strings first), and then arranged 
the drawing paper, prepared his India ink and brushes, 
took the parallels and pencils and laid off the space, 
and worked for half an hour or more rapidly and per- 
fectly, nearly completing the figures on pp. 596 and 
597 of Carpenter's Principles, in the edition of 1853. 
. . . These drawings are now in the series used for 
illustration in Kush Medical College. Although we 



188 INSOMNIA. 

had a light in the room while watching him, he went 
on with his work entirely regardless of it. Before 
completing the work, he went to bed and slept until 
the usual hour in the morning, when at the breakfast 
he asked if he had been up in the night, as he had 
dreamed that he had. This was the only time he ever 
remembered even dreaming about being up or occu- 
pied in anything. He had by this time become so 
fully aware of his habits, that nothing of the sort 
astonished him. Shortly after this he went to spend 
the night with a fellow student, but a little after mid- 
night he rose, dressed himself, and went out, followed 
by the other gentleman, walked down to the Exchange 
Hotel, where there were a number of his acquaint- 
ances and others waiting for a train of cars due at that 
time. Some one rallied him on his being out so late, 
but being cautioned by his companion, they did not 
attempt to awake him, but watched his movements. 
On being invited, he took a glass of ale, and then said 
he would only have time to go home and get his dinner 
before the afternoon lecture hour. He walked with 
his friend to our door, and was indignant to find it 
locked. His room-mate (a cousin) admitted him and 
awakened myself and wife. He asked if dinner was 
ready, and seemed astonished that it was not ; then said 
he would get a drink of water and be off, ' for old D. 
(one of the faculty) would be mad if he was late/ I 
told him he had plenty of time and he need not be in 
a hurry. He then walked into the kitchen, drank a 
tumblerful of water, and, looking up to the clock, 
although it was totally dark, remarked the time, and 
started for the front door. I then told him that I was 



SOMNAMBULISM. 189 

not feeling well, was pretty blue, and wished he would 
sit down and play euchre with us. This seemed to 
please him, and he took off his overcoat and said he 
had as lief play until 'old D.' was through lecturing, 
as to go. 

" His cousin sat down at the table with us, and we 
played ' three-handed (cut-throat) euchre.' He paid 
not the slightest attention to us, although we passed 
the cards backwards and forwards between us, exchang- 
ing hands, and everything we could do to attract his 
attention. He dealt the cards in his turn, correctly, 
and played ' according to Hoyle.' In one hand, spades 
were trumps, and he held the jack of clubs. Clubs 
being led, he first threw down this jack, then quickly 
picked it up, saying, 'I forgot that was the left bower.' 
It is somewhat humiliating to record that, notwith- 
standing our tricks and devices, he beat us in the 
game. 

" On its conclusion, he got up hastily and insisted 
upon going to the college. We only prevented him 
this time, by throwing water in his face — the only 
method, by the way, in which we could awake him 
without great violence. Pungent odors, ammonia, 
camphor, etc., he seemed to disregard, or merely 
pushed away the object. 

" On regaining consciousness, he always appeared 
like one stunned, or suffering from a severe shock. 
The influence upon the pulse and nervous system was 
always so severe, that we never awaked him at these 
times if we could avoid it. 

" Whenever a little out of health, as from trifling 
attacks of indigestion, or after watching with the sick, 



190 INSOMNIA. 

or fatigue, he would be sure to be up and doing some- 
thing notable in the somnambulic state. 

" One of the most remarkable of his exploits occurred 
several years after the incident just given. I think it was 
in 1860 or 1861. ... In the rounds of his prac- 
tice he had a patient, about whom he was very anxious. 
It was in the coldest winter weather, and the residence 
of the patient was about two miles distant. Visiting 
him early in the evening, he found him in a state so 
unsatisfactory, that he informed the family that if he 
did not find him better the next visit, he should change 
the medicine entirely. On rising the next morning, 
he went to the barn to put his horse to the cutter for 
an early start. He was a little puzzled at finding 
things somewhat misplaced, but supposed some person 
had been at the stable in search of a missing article. 
On visiting the patient, he was gratified to find a 
marked improvement. He inquired when the improve- 
ment commenced, and was answered, ' Immediately 
after taking the powders which he had given in the 
night.' The truth flashed upon him at once, but con- 
cealing his emotion, he inquired, with as careless an 
air as he could assume, ' About what time was it when 
I was here?' They replied, 'Between tAvo and three 
o'clock.' This proved to have been the case, as he 
was afterwards told by the family where he boarded. 
He had been giving the patient some fluid medicine, 
which he ordered discontinued, and then put up several 
powders, such as he had concluded upon the night 
previous, combining them as usual, and administering 
the first one himself." 

The foregoing examples illustrate the fact that 



SOMNAMBULISM. 191 

ordinary vision is not necessary to guide the move- 
ments of the somnambulist. Sometimes the patient 
walks about with open eyes; on other occasions they 
are firmly closed. It is generally admitted that the 
tactile and muscular senses are greatly exalted, so that 
they furnish guiding sensations which are sufficient to 
direct the most complicated movements. The history 
of the medical student observed by Dr. Allen shows 
how preter naturally sensitive the organs of vision may 
become — actually seeing the clock in the dark during 
the somnambulic paroxysm. When one considers the 
remarkably hyperaesthetic condition of the senses in 
certain other forms of nervous disorder, it is not sur- 
prising that sensory impressions which would be 
wholly neglected in a healthy waking state, may 
become sufficient to excite perceptions and to guide 
the movements which they have aroused. It is 
undoubtedly true that in certain cases the somnam- 
bulist does derive some information through the me- 
dium of the eyes — does really see ; but it is also a fact 
that he only sees, hears, tastes and feels the objects 
which are immediately related with the action of his 
dream. It appears also that an impression derived 
from any organ of sense may suffice to arouse any 
other or all of the internal organs of perception, so 
that the patient seems to see, to hear, and even to 
taste objects which he knows only through the sense of 
touch. Sometimes the image thus externalized coin- 
cides with the actual reality; but often this is not the 
case, as, in the experience of the young clergyman, 
the somnambulist seemed to see the paper which he 
only perceived through contact with his fingers. The 



192 INSOMNIA. 

image thus created corresponded exactly with the 
external fact; but when a similar contact with a pile 
of bed-clothes excited the illusion of a drowning 
child in his grasp, the internal image did not in the 
least correspond with the external object, and he 
probably derived no information through the sense 
of sight in either case. In another instance, how- 
ever, as we shall learn upon another page, the subject 
is so far dependent upon the sense of sight that its 
obstruction is sufficient to arrest his movements, as 
certainly as if he were awake. 

Ordinarily the memory is not impressed by the 
events of the somnambulic dream, but we have already 
learned that it is sometimes affected precisely as in 
common dreaming. One of my. little acquaintances 
could not find her night-dress when she went to bed 
one night. She was therefore obliged to wear a gown 
that was old and ragged. Later in the evening her 
sister discovered the missing garment, and laid it over 
a chair in the bed-room. In the morning the night- 
dresses had changed place, and the ragged one occu- 
pied the chair. This occasioned considerable surprise, 
until the child remembered that during the night she 
had dreamed that two of her playmates had come to 
sleep with her, and that she felt so mortified at being 
seen in a ragged dress that she got out of bed and 
changed her night-gown. Sometimes the events of a 
somnambulic paroxysm are remembered during a 
subsequent attack, though they are forgotten during 
the interval, as in a case, reported by Macario, of a 
young girl who had been violated during somnam- 
bulic sleep. On awaking she had no idea of anything 



SOMNAMBULISM. 193 

that had occurred, but during a subsequent paroxysm 
she told her mother all that had happened. 1 In cer- 
tain cases a dim recollection of some particular inci- 
dent may be retained, as in the case of my patient 
who was for eight weeks in the somnambulic state. 
On recovery, the only thing that she could remember 
was a momentary glimpse of some one who was hold- 
ing up his fingers before her eyes. Meeting the phy- 
sician, subsequently to her recovery, who had thus 
attempted to arouse her attention, she recognized in 
his countenance the features which had momentarily 
impressed her consciousness during the period of 
somnambulic life. 

It is seldom observed that somnambulism is attended 
with dangerous tendencies, yet they are sometimes 
present. One of my patients once took by mistake 
ninety grains of chloral at a single dose. While under 
its effects she got out of bed, walked into her sister's 
n n >m, shook her fist in her face, and swore furiously at 
her. On awaking, next morning, she was greatly 
shocked by the account of this dreadful behavior, so 
utterly at variance with her usual temper and charac- 
ter. Another somnambulic patient one night rushed 
into her mother's room, violently accusing her of steal- 
ing her pocket-book, and threatening vengeance if it 
were not returned. Such patients sometimes mislay 
the articles with which they occupy themselves during 
a paroxysm, and on waking they erroneously infer that 
they have been robbed. Sometimes, as in the cele- 
brated case related by Mesnet, the natural propensities 
of the individual seem to be released from all restraint, 

1 Maury, Le Sommeil et les Reves, p. 234. 
13 



194 INSOMNIA. 

and brutal instincts guide the actions of the somnam- 
bulist, who then steals, or eats and drinks with the 
voracity of a savage. Ball and Chambard (he. cit) 
have collected a number of examples in which impulses 
to suicide or other forms of violence were manifested 
under such circumstances. Obviously, where the 
moral sense is asleep, and where the affection is the 
result of causes beyond the control of the m patient, he 
cannot be held morally responsible for the conse- 
quences of such actions. His condition closely resem- 
bles that of the victim of epileptic mania who delivers 
himself during a paroxysm to all degrees of furious 
and homicidal violence, without retaining the slightest 
recollection of the fact after its conclusion. The close- 
ness of the parallel between these two disorders is 
rendered further apparent by the circumstance that 
although all memory of the events of epileptic mania 
is usually abolished, it does sometimes persist after the 
termination of the attack. Thus, one of my epileptic 
patients for a time manifested symptoms of insanity 
after every fit. During one of these paroxysms he 
imagined that the sparrows on the housetop were all 
singing a particular tune which had attracted his atten- 
tion shortly before the convulsion. Then it seemed to 
him that the breathing of his sleeping child whispered 
the same tune. Placing his hand upon the bosom of 
his wife, her breathing assumed the same musical 
character. Calling upon his family to listen to the 
wonderful music, they all asserted that they too could 
hear it. It was a considerable time after his recovery 
before he could be convinced that this vividly remem- 
bered experience was a pure illusion. The members 



SOMNAMBULISM. 195 

of his family had been cautioned against contradicting 
their father during his paroxysms ; consequently, when 
he asked if they could hear the melody which delighted 
him. they answered affirmatively, and thus confirmed 
him in his delusion. To the ordinary form of epileptic 
mania such paroxysms sustain a relation similar to that 
subsisting between ordinary dreams and the somnam- 
bulic experience. 

In like manner as it is often remarked that certain 
dreams betray a condition of unusual cerebral excite- 
ment, so do certain cases of somnambulism manifest a 
delirious exaltation of the faculties in action. This 
characteristic often belongs to the night-terrors of 
children. It is a condition in which the brain is occu- 
pied by the scenery of a vivid and highly dramatic 
vision which dominates the actions of the subject. 
This was most conspicuously shown in the following 
case, from J. P. Frank, 1 and in certain periods of the 
paroxysms observed by Mesnet (p. 198). Frank's 
patient was a healthy and well nurtured young Ger- 
man girl, who during the wars of 1812 had been terri- 
bly alarmed by a party of French soldiers who had 
broken into the house and threatened to kill her father. 
The next day at the same hour she passed into a som- 
nambulic state, which lasted till sunset. After a brief 
introductory period of agitation, she uttered a deep 
sigh, which was rather a sob than a sigh, and fell into a 
profound sleep. Presently she smiled, her countenance 
seemed lighted with inspiration, her right arm was 
raised in the air, and the left was directed towards the 
earth. In this cataleptic attitude she remained for 

1 Pathologic interne. 



196 INSOMNIA. 

about a minute. She then seemed to have decided 
what to do; from an imaginary cartridge-box behind 
her back she pulled out a cartridge, bit off the end, 
poured out the powder upon her fist as if she were 
priming a musket. She then went through the motions 
of loading a gun, ramming down the wad with an 
imaginary ramrod, and cried out in French, a language 
which she had never heard before: "Marche! Ou est 
le baron? Sacre nom de Dieu!" Repeating the 
violent ejaculations and threats addressed by the 
soldiers to her father, she exhibited the utmost terror; 
her body was covered with a cold sweat, and she seemed 
ready to faint away. At this moment she woke up, 
called impatiently for her handkerchief, with which 
she wiped the perspiration from her face, and resumed 
her ordinary avocations as if nothing had happened." 

Still more remarkable was the case reported by Dr. 
Mesnet. 1 From the excellent translation prepared by 
T. J. Huse, M. D., 9 the following sketch has been out- 
lined : 

The patient, aet. 27 years, received in one of the 
battles near Sedan, during the Franco-Prussian war, 
a bullet wound which fractured the left parietal bone. 
His right arm was almost immediately paralyzed ; after 
a few minutes the paralysis involved the right leg, and 
he lost consciousness. It was only after the lapse of 
three weeks that he recovered his senses. He was 
finally taken to Paris, where the paralysis gradually 
disappeared. From a period some three or four 
months after the reception of the injury, he began to 

1 L' Union Mtdicale, July 21st and 23d, 1S74. 

9 Chicago Journ. of Nervous and Mental Diseases y Vol. II, p. 4S. 



SOMNAMBULISiU 197 

manifest periodical attacks of somnambulism, at inter- 
vals of fifteen to thirty days with an average duration 
of fifteen to thirty hours. During the whole of this 
time his life presented two essentially distinct phases 
— the one normal, the other pathological. In the 
normal condition he was able to gain a livelihood. He 
had been a clerk in several houses, a singer in a cafe, 
and while in the hospital had made himself useful and 
agreeable. The somnambulic attacks which he experi- 
enced were characterized by an instantaneous onset, 
resulting in the abolition of all his senses except the 
tactile sense. Sight was perhaps partially persistent, 
for on many occasions he seemed to be impressed by 
brilliant objects, but he was obliged to employ the 
sense of touch in order to understand their form, 
volume, etc. During all these crises his gait was easy, 
his attitude calm, his countenance peaceful; his eyes 
were widely open, with dilated pupils; the forehead 
and brows were contracted; there was an incessant 
nystagmus, indicating a disordered state in the brain; 
he was continually mumbling or muttering. When 
walking in a familiar locality he moved with perfect 
freedom ; but if in a strange place, or if obstacles were 
placed in his way, he examined the obstructions by 
feeling of them with his hands, and turned easily aside. 
If any attempt was made to change his direction, or to 
quicken or retard his pace, he allowed himself to be 
directed like a mere automaton, continuing to walk in 
any way thus chosen for him. He would also eat, 
drink, smoke, dress himself, walk out, and retire to bed 
as usual. These processes seemed to be effected as a 
result of previous habit, without any actual conscious- 



198 INSOMNIA. 

ness or feeling. He ate voraciously without discern- 
ment, and drank in the same manner ordinary wine, 
wine of quinine, water, assafcetida, without exhibiting 
any evidence of sensation whatever. 

While under treatment in the Saint Antoine Hos- 
pital, this patient was carefully studied by Dr. Mesnet 
and by Alfred Maury, the celebrated author. They 
found that by means of impressions upon his tactile 
sensibility it was possible during any one of his 
paroxysms to suggest certain modes of action which 
were reproduced whenever he was again placed in the 
same conditions. Thus, " he was promenading in the 
garden, under a grove of trees, when some one put 
back into his hand the cane which he had let fall a 
few moments previously. He felt of it, turned his 
hand several times around the curved handle of the 
cane, became attentive, seemed to listen, and suddenly 
cried out, ' hurry ! ' then, ' there they are ! there are at 
least twenty of them, to the two of us ! we shall get the 
better of them ! ' and then, carrying his hand behind 
his back, as if to get a cartridge, he went through the 
movements of loading his musket, crouched at full 
length in the grass, concealing his head behind a tree, 
in the posture of a sharp-shooter, and following with 
his gun at his shoulder all the movements of the 
enemy whom he seemed to see close at hand. This 
scene often repeated in detail during the course of the 
observations, has seemed to each of us the most com- 
plete expression of an hallucination called up by an 
illusion of touch, which, giving to a cane the proper- 
ties of a gun, awakened in this person remembrances 



SOMNAMBULISM 199 

of his last campaign, and reproduced the struggle in 
which he was so grievously wounded." 

On another occasion the patient was at the end of a 
corridor, near a door that was locked; he "passed his 
1 lands over this door, found the knob, grasped it, and 
attempted to open it; failing to accomplish this, he 
sought for the keyhole, then for the key, which, how- 
ever, was not there ; then, passing his fingers over the 
screws which secured the lock, he endeavored to seize 
them and turn them for the purpose of detaching the 
lock. Wis entire series of actions hears witness to an 
effort of his mind connected with the object before him. 
He was on the point of leaving the door and turning 
towards another room, when I held up before his eyes 
a bunch of seven or eight keys; he did not see them; I 
jingled them loudly at his ear; he did not notice them; 
placing them in his hand, he immediately took hold of 
them, and tried them one by one in the keyhole, with- 
out finding the single one which could fit; he then left 
the place, and went into one of the wards, taking in his 
passage various articles with which he filled his pockets ; 
at length he came to a little table used for the records 
of the wards. He then passed his hands over the 
table, but it was empty; in feeling of it, however, he 
came across the handle of a drawer ; opening it, he took 
up a pen, and all at once this pen suggested to him the 
idea of writing; for at that moment he began to ran- 
sack the drawer, taking out and placing on the table 
several sheets of paper, and also an inkstand. He then 
sat down and commenced a letter, in which he recom- 
mended himself to his commanding officer for his good 
conduct and bravery, and made application for the 



200 INSOMNIA. 

military medal. This letter was written with many 
mistakes in it, but these were identical as regards 
expression and orthography with all £hat we have seen 
him make in his healthy state. While the patient was 
writing, he aided us in an experiment that encouraged 
to immediately examine in what degree the sense of 
sight assisted in the performance of this action. The 
facility with which he traced his letters, and followed 
the lines upon the paper, left no doubt concerning the 
exercise of vision upon the writing; but, in order to 
make the proof satisfactory, we have several times 
interposed a thick plate of sheet-iron between his 
hands and his eyes when he was writing ; and, although 
all the visual rays were intercepted, he did not imme- 
diately break off the line he had begun ; he still con- 
tinued to trace a few words written in an almost 
illegible manner with the letters entangled in each 
other; then finally he stopped without manifesting 
either discontent or impatience. The obstacle removed, 
he finished the uncompleted line, and began another. 
The sense of sight was therefore in full activity, and 
essential to the written expression of the patient." Other 
observations showed that the sense of sight was only 
roused at the instance of touch, and that its exercise 
remained limited to those objects alone with which it 
was actually connected by the touch. 

On another occasion he passed through a long ward 
of patients, " taking indiscriminately every article that 
came within his reach, and concealing them afterwards 
under the quilt, under a mattress, under a chair-cover, 
and under a pile of sheets. Arrived in the garden, he 
took from his pocket a book of cigarette papers, opened 



SOMNAMBULISM. 201 

it, and detached a leaf from it; then took out his 
tobacco and rolled a cigarette with the dexterity of one 
who is accustomed to this proceeding. He searched 
for his match-box, lighted his cigarette with a match, 
which falling still burning on the ground, he extin- 
guished by placing his foot upon it ; then smoked his 
cigarette while strolling back and forth to the entire 
extent of the garden, without any of these actions pre- 
senting the slightest deviation in their manner from 
the ordinary method. Everything that he did was 
the faithful reproduction of his ordinary round of 
life. 

"This first cigarette terminated, he prepared to 
make another, when we stepped up and began to inter- 
pose obstacles. . . . He searched vainly in his 
pocket for his tobacco, as we had filched it. He 
searched for it in another pocket, going through all his 
clothes until he came back to look for it in the first 
pocket, when his face expressed surprise. I offered 
him his tobacco-pouch, but he did not perceive it; I 
held it near his eyes, yet he still did not perceive it; 
even when I shook it just in front of his nose, he did 
not notice it. But when I placed it in contact with his 
hand, he seized it and completed his cigarette directly. 
Just as he was about to light his cigarette with one of 
his matches, I blew it out and offered him instead a 
lighted match which I held in my own hand; he did 
not perceive it; I brought it so close to his eyes as to 
singe a few lashes, yet he still did not perceive it, 
neither did he make the slightest motion of blinking. 
The patient sees certain objects and does not 
perceive others ; his sense of sight receives impres- 



202 INSOMNIA. 

sions from all objects in personal relation with him- 
self through the touch, and does not receive impres- 
sions, on the contrary, from things external to him ; he 
perceives his own match, but does not perceive mine." 

During the course of this observation the patient 
gave evidence that the memory of his former occupa- 
tion as a professional singer had been revived. He 
began to hum some of the familiar airs, and then pro- 
ceeded to his room in the hospital, where he carefully 
dressed himself as if for a public performance. " On 
his bed he chanced to meet with several numbers of a 
periodical romance, which he turned rapidly over with- 
out finding that for which he was searching. 
I took one of those numbers, rolled it up, and putting 
it into his hand in that condition, satisfied his want 
by this semblance of a roll of music, for he then took 
his cane, and traversed the ward with a slow step, well 
contented. When stopped on his way, for the purpose 
of taking off the coat he was wearing (which had been 
foisted on him by one of the observers), he permit- 
ted it without offering any resistance. ... At 
this moment the sun lit up with a bright ray a glass 
window that closed the lodge on the side towards the 
court. . . . This ray must have given him the 
impression of a footlight, for he at once placed him- 
self before it, readjusted his toilet, opened the roll of 
paper which he carried in his hand, and softly hummed 
an air, running his eyes over the pages as he slowly 
turned them, and marking with his hand a measure 
that was perfectly rhythmical. Then he sang aloud, 
in a highly agreeable manner, giving his song the 
correct expression, a patriotic ballad to which we all 



SOMNAMBULISM. 203 

listened with pleasure. This first selection termina- 
ted, he sang a second, and afterwards a third. We 
then saw him take out his handkerchief to wipe his 
face. I offered him a wine-glass of a strong mixture 
of vinegar and water, which he did not notice; I placed 
the glass under his nose without his perceiving the 
smell of the vinegar; I put it into his hand, and he 
drank it without complaining of any unpleasant sen- 
sation." 

The conclusions which may be drawn from this 
remarkable history have been sufficiently expressed by 
Dr. Mesnet 1 in the following words: 

" The disturbance which these functional perversions 
of the nervous system bring into the course of life, 
extends not only to the organs of sense, and to intel- 
lectual actions properly so called, but it also some- 
times awakens some instinctive excitation which 
surrenders the individual without any defence, and 
destitute of rational discernment, to the most deplora- 
ble impulses. He acts with the semblance of a free- 
dom which he does not possess; he seems to prepare 
and to combine certain actions in the light of conscious 
volition, when he is in reality only a blind instrument, 
obedient to the irresistible mandates of an unconscious 
impulse." 

The bearing of these conclusions upon the ques- 
tion of the moral responsibility of the somnambulist 
needs no further advertisement. 

The likeness of certain features of such cases to 
the phenomena of hypnotism is worthy of note. In 
this particular there is an evident likeness between the 

1 Loc. cit. 



204 INSOMNIA. 

cerebral susceptibility of the ordinary dreamer, the 
somnambulist, and the hypnotised subject. All are 
alike in a condition which renders their imagination 
and their volition subservient to guiding sensations 
from without, so that their movements may be directed 
by the will of another. We have seen how the course 
of an ordinary dream may be modified by such sugges- 
tions. The history of the patient just related, illus- 
trates the manner in which the actions of a somnam- 
bulic dreamer may be controlled by the will of a 
spectator. The ordinary phenomena of hypnotism 
exhibit the same subjection to the will of another. It 
is probable that a considerable part of the superior 
notoriety which belongs to this feature of hypnotism, is 
due merely to the fact that natural somnambulism is 
rarely made the object of such experiments and obser- 
vations as are daily applied to the subjects of artificial 
somnambulism. 

Somnambulic Life. — We come now to the last term 
of the series, the simplest, yet perhaps the rarest 
form of the affection. In this form, the patient seems 
perfectly awake ; he is in possession of all his senses ; 
he is capable of sustained and rational volition; he 
lives and behaves, in short, like any other person. But 
his life is divided into periods which are, so far as 
consciousness is concerned, completely distinct from 
each other. This double-consciousness may be exhib- 
ited but once in a lifetime, or it may be frequently 
repeated, so that the patient oscillates between the two 
states until it becomes doubtful which is the natural 
condition and which is the acquired. These states of 
double-consciousness are divided from each other by a 



SOMNAMBULIC LIFE. 205 

more or less complete break in the chain of memory. 
The residual strata which, so to speak, have been 
deposited from the sea of events upon the floor of 
memory, have become broken and " faulted." The 
line of rupture marks the division between the two 
fields of consciousness ; they no longer lie in the same 
plane, consequently there can be little or no continu- 
ity of memory between them. The events which 
transpire in one state affect the mind so long as, 
and whenever it is in connection with the cerebral 
register which is fitted to that state; as soon as the 
connection is shifted, the mind takes cognizance of 
the events that are recorded upon the other portion 
of the register, but, for want of physical continuity 
between the different portions of the record, the mind 
cannot at once receive a continuously connected report 
from the entire organ of recollection. From this 
lesults a mode of life essentially similar to the life of 
certain epileptics who are ushered by each seizure into 
a state of apparently conscious activity of which they 
have no recollection after recovery. Thus, one of my 
epileptic patients, who was subject to seizures, both 
of the convulsive and the non-convulsive form of the 
disease, on one occasion left home, after a fit, and 
traveled a considerable distance into the country, put- 
ting up for the night at taverns and farm houses, and 
apparently behaving like any other respectable citi- 
zen. It was three weeks before he came to himself. 
On recovering his normal consciousness, the period 
of his wanderings was a perfect blank in his memory. 
Such attacks are usually of shorter duration, and are 
more frequently associated with hysteria; bearing to 



206 INSOMNIA. 

the hysterical paroxysm the same relation which they 
share with the epileptic fit. When the predisposing 
temperament exists, a great variety of excitations may 
serve to produce the phenomena, so that unless care- 
ful observation is employed, the truly somnambulic 
character of the paroxysm may easily be overlooked. 
Thus, the true nature of the affection was not sus- 
pected by the early attendants of the patient who 
became the subject of lethargic stupor, as related on 
page 173. Under the influence of powerful drugs act- 
ing upon a highly sensitive nervous organization, she 
became, at first, " hystericky." She manifested great 
distress, complained bitterly of her sufferings, passed 
through the ordeal of several consultations, was sub- 
jected to a considerable surgical operation, and only 
ceased to appear conscious at the expiration of five 
weeks, when she passed into the lethargic state previ- 
ously described. At the time of my first visit, just 
before the commencement of stupor, she walked into 
the room where I was waiting, greeted me with her 
usual affability, gave me some account of her sensa- 
tions, and neither did nor said anything that could 
lead me to suspect that she was not in her normal 
frame of mind. But, with the exception of the single 
incident mentioned on page 193, the entire period from 
the commencement of her medication to the close of 
the lethargic stupor was utterly blotted out of her 
recollection. 

Macnish 1 relates a similar case of a young lady who 
k " unexpectedly, and without any forewarning, fell into 
a profound sleep which continued several hours beyond 

1 Philosophy of Sleep, p. 167. 



SOMNAMBULIC LIFE. 207 

the ordinary term. On waking, she was discovered to 
have lost every trace of acquired knowledge. Her 
memory was tabula rasa — all vestiges, both of words 
and tilings, were obliterated and gone. It was found 
necessary for her to learn everything again. She even 
acquired, by new efforts, the art of spelling, reading, 
writing, and calculating ; and gradually became 
acquainted with the persons and objects around, like a 
being for the first time brought into the world. In 
these exercises she made considerable proficiency. But, 
after B few months, another fit of somnolency super- 
vened On rousing from it, she found herself restored 
to the state she was in before the first paroxysm; but 
was wholly ignorant of every event and occurrence that 
had befallen her afterward. During four years and 
upwards she has passed periodically from one state to 
the other, always after a long and sound sleep. . . . 
The former condition of her existence she now calls 
the Old State, and the latter the New State; and she 
is as unconscious of her double character as two dis- 
tinct persons are of their respective natures. For 
mple, in her old state she possesses all the original 
knowledge; in her new state only what she acquired 
since. It a lady or gentleman be introduced to her in 
tin 1 old state, or vice versa (and so of all other mat- 
ters), to know them satisfactorily she must learn them 
in both states. In the old state, she possesses fine 
powers of penmanship, while in the new, she writes a 
poor, awkward hand, not having had time or means to 
become expert. Both the lady and her family are now 
capable of conducting the affair without embarrass- 
ment. By simply knowing whether she is in the old 



208 INSOMNIA 

or new state, they regulate the intercourse, and govern 
themselves accordingly." 

Another remarkable case was reported at length by 
Dr. Azam, of Bordeaux. ' The principal facts are given 
in a translation by Dr. J. I. Tucker in the Chicago 
Journal of Nervous and Menial Disease. 9 The patient 
was a young woman who began to exhibit the symp- 
toms of hysteria at the age of puberty, and from that 
time till the present, a period of nearly thirty years, 
she has lived a double life, passing alternately from 
normal life into somnambulic life. These transitions 
were ushered in by a sharp pain in both temples, fol- 
lowed by a species of stupor, lasting about ten minutes. 
She would then open her eyes, apparently awake, and 
would remain in the condition of somnambulic life for 
an hour or two, when the languor and sleepiness would 
reappear for a few minutes, after which she would 
awaken in her normal state. At first these paroxysms 
were renewed every five or six hours ; but, as she grew 
older, they occurred less frequently, and were greatly 
prolonged, until, finally, the periods of somnambulic 
life considerably exceeded the duration of normal life. 
During normal life she was hypochondriacal, hysterical, 
and a sufferer with neuralgia. During somnambulic 
life she was free from pain, lively, imaginative, and 
coquettish. While in this state of existence she 
remembered the events of her entire life — normal or 
otherwise ; but on returning to her natural mode of life, 
she retained no recollection of her somnambulic periods. 

1 Revue Scientifique, May 20, Sept. 16, 1876; Dec. 22, 1S77: March 
8, 1879. 

■ Vol. Ill, p. 5S4. 



SOMNAMBULIC LIFE. 209 

Memory, during normal life, was limited to anterior 
normal periods. As time advanced, this peculiar mode 
of existence became an increasing source of inconveni- 
ence and mental distress, often leading the superficial 
observer to suppose that she was insane. 

This case differs from the others in the circum- 
stance that the period of somnambulic life was more 
vigorous and healthy than the ordinary condition. This 
seems to suggest an explanation of the forgetfulness 
which marked the period of normal life. During that 
period tin* functions of the brain were depressed, so 
that its molecular movements could not reach the level 
of the field of consciousness occupied during the second 
period Other observations, such as that of Sir Henry 
Holland, 1 who. while exhausted by fatigue, lost all 
1 lection of the German language until he was 
restored by rest and food, indicate that such defects of 
memory depend upon a deficient nutrition of the brain 
Bubstana — a condition which is undoubtedly associated 
with an enfeebled cerebral circulation. We may, there- 
for.', suppose that in Dr. Azam's case the paroxysms of 
somnambulic life were induced by periodical discharges 
of force within the brain, causing an improvement in 
the circulation of blood, and a corresponding gain in 
health and general vivacity. Such exaltation of the 
faculties would be perfectly consistent with an exercise 
of memory covering all the events of life. But, when, 
as in cases like that reported by Macnish, and by my- 
self, somnambulic life is the result either of disease or 
simple somnambulic sleep, it is a condition in which, 
as in physiological sleep, the cerebral functions, taken 

1 Chapters on Mental Physiology, p. 160. 
14 



210 INSOMNIA. 

as a whole, are depressed rather than exalted. The 
resulting train of ideas is developed upon a plane below 
the level of ordinary consciousness, and is, conse- 
quently, as easily forgotten as the dreams which are 
developed during sleep. 

Such, then, are the principal characteristics of som- 
nambulism — a state in which dreams are supplemented 
by more or less complete and appropriate action; ordi- 
narily without subsequent recollection of either dream 
or action. The somnambulic dream usually occurs 
during or soon after the period of deepest sleep, when 
the influences of the external World are most completely 
suppressed. Released from the control of its sensory 
portion, the remainder of the brain awakens, and 
becomes aroused to a condition of relative exaltation. 
No longer distracted by the solicitations of external 
sense, the attention is concentrated upon the hallucina- 
tions which constitute the dream. In the simpler 
forms of noctambulism only the automatic locomotive 
apparatus is awakened, and the sleeper moves in accord- 
ance with the impressions derived from habit, aided by 
actual exaltation of the muscular and tactile senses. 
But, in some of the more complicated cases, a certain 
amount of special sensibility seems to exist. The 
patient is capable of exercising just that amount of 
perception which is necessary to accomplish his pur- 
pose, though blind and deaf and insensible to every 
other impression. The more complete the waking of 
the sense-organs, the closer the resemblance to the 
condition of ordinary life, or even to the condition of 
ecstasy, in which cerebral exaltation is the prominent 
feature, and in which the power of recollection gen- 



SOMNAMBULISM. 211 

erally persists. Accordingly, it sometimes happens 
that the somnambulist can recall the events of his 
paroxysm. In such cases the power of recollection is 
due to the same conditions that control the recollection 
of our ordinary dreams. But the phenomena of ordi- 
nary somnambulism are as completely as possible 
removed from all connection with the mental actions 
which arise directly from the operation of the senses. 
By reason of such isolation the ordinary association of 
ideas affords no help to the memory, and the dream 
remains in oblivion. Alfred Maury expresses the 
opinion ' that the principal cause of forgetfulness of the 
events of Bomnambnlism consists in the exhaustion of 
tin 1 cerebral elements through the intensity of the 
excitement to which they have been subjected during 
the paroxysm. Doubtless this, in certain cases, may 
contribute to the loss of memory, but it should be 
remembered that the excitement may be relative rather 
than absolute. Certain elements wake while others are 
asleep; and these waking cells may be aroused to a 
«1» i^ree far in excess of what is usual during the sleep 
of the brain without attaining to the level of their 
diurnal activity. The mind, undisturbed by external 
impressions, gives its attention to the operation of 
these waking organs, and a dream with all its conse- 
quences, somnambulic or otherwise, is the result. In 
other words, the plane of consciousness, so to speak, is 
h >wered in sleep to the level of these molecular vibra- 
tions. But when the entire brain has been completely 
reawakened, the residual vibrations of those elements 
which yielded the physical basis of the dream, and 

1 Le Sommcil et les Reves, p. 226. 



212 INSOMNIA. 

which, had they originally occurred during the waking 
state, might have persisted with energy sufficient to 
furnish a groundwork for recollection of the ideas 
which they had first suggested, are no longer sufficiently 
forcible to be felt in consciousness. Recollection of 
mental states thus generated must necessarily be 
impossible under such conditions. Sometimes, how- 
ever, the somnambulist who, while awake, had forgot- 
ten all the incidents of his somnambulic experience, 
can remember, in a subsequent paroxysm, all that 
occurred during the preceding attack. Facts of this 
kind have been observed in the waking life of certain 
hysterical persons, but the apparent doubling of their 
personality is connected with the waking state, or with 
its semblance, while in ordinary somnambulism it is 
only during sleep that the alternations of memory and 
forgetfulness occur. A similar recollection of previous 
visions is sometimes experienced in dreams, showing a 
close relationship between the dreams of sleep and of 
somnambulism. The bond of association between 
events thus isolated in time must be sought in a 
renewal of like conditions of the brain during the suc- 
cessive periods of somnambulic exaltation. We must 
suppose that the molecules which were in a state of 
excitement during the first paroxysm are again aroused 
in a similar manner after a period of waking quies- 
cence. If, during sleep, their movements, though of 
an exalted character, have only just sufficed to arouse 
consciousness in the form of a dream, it is scarcely 
probable that during the phase of comparative inac- 
tivity which supervenes when the whole brain is awake, 
their residual motion could disturb the sphere of con- 



SOMNAMBULISM. 213 

sciousness. Hence the time occupied by their som- 
nambulic vigor must remain a blank in memory during 
the waking state. But, when the original state of 
relative exaltation has been reproduced by a second 
paroxysm of disorder, if the same molecular move- 
ments be in any way renewed, the conditions of 
memory are fulfilled; consciousness is once more 
aroused as before, and the patient remembers the 
dream or the events of the previous attack. 



CHAPTEK Vn. 

ABTIFICIAL SOMNAMBULISM OR HYPNOTISM. 

There are more things in heaven and earth, Horatio, 
Than are dreamt of in your philosophy. 

—Hamlet. 

The phenomena of somnambulism are of apparently- 
spontaneous origin, during ordinary sleep. But from 
the remotest antiquity it has been known that certain 
persons may be thrown into an artificial sleep which 
closely resembles the condition of the somnambulist. 
Such a degree of susceptibility is not common to all 
persons. Heidenhain, experimenting upon his class of 
medical students, found only one in twelve who was 
thus susceptible. My own experiments lead me to 
think that American medical students are less easily 
influenced in this direction. Charcot, whose field of 
observation covers the inmates of the Salpetriere Hos- 
pital, finds the best examples of the hypnotic state 
among the hystero- epileptic females in that asylum. 
To the experiments of Heidenhain, in Germany, of 
Braid, in England, and of Charcot, in France, we are 
indebted for the most thoroughly scientific observation 
and interpretation of the phenomena of hypnotism. 

The antecedent physical condition most favorable to 
the development of the hypnotic state is a highly 
unstable constitution of the nervous system. For this 

0*14) 



HYPNOTISM. 215 

reason the larger number of qualified subjects is 
furnished by the female sex — especially by those who 
possess the hysterical temperament. Frequent repeti- 
tion of hypnotic exercises renders the subject still 
more susceptible. Heidenhain was, at first, inclined 
to the belief that such experiences were not prejudicial 
to the health of the subject, but the observations of 
Harting. in the University of Utrecht, and of Milne- 
Edwards, in Paris, 1 have demonstrated the fact of 
danger to the health of animals subjected to similar 
experiments. Hysterical patients have often exhibited 
considerable exhaustion after hypnotic exhibition in 
the hospitals of Paris (Charcot and Richer), conse- 
quently, it cannot be admitted that the practice is 
devoid of risk to the health of the individual. 

Numerous methods of inducing the hypnotic state 
have been employed. The greater number consist in 
artificial modification of the condition of the brain 
through the agency of sensory impressions originated 
upon the periphery of the body. The simplest form 
of such influence is presented by the results of gentle 
friction of the skin with the palm of the hand or the 
tips of the fingers. Many an aching head has thus 
been relieved, many a restless sufferer soothed to sleep. 
In like manner, a susceptible subject may be hyp- 
notized by any continuous and gentle excitement of the 
senses of sight, hearing, and touch. Concentration of 
the attention upon a brilliant object, like a piece of 
polished metal or a small mirror, especially if it be 
placed a little above the level of the eyes, and so near 
that considerable convergence of the eyeballs is neces- 

1 Lancet, July 29, 1882, p. 164. 



216 INSOMNIA. 

sary for distinct vision, affords a very efficient means 
of inducing artificial somnambulism. Certain persons 
may be readily hypnotized by gently pressing the eye- 
lids together, and at the same time making slight 
pressure upon the eyeballs. Others pass into this 
condition by merely closing their eyes, and remaining 
motionless in a quiet room. 

The. phenomena of artificial somnambulism are 
frequently developed through the agency of im] 
sions derived directly from the sphere of conscious- 
ness. The intellectual effort of faying to sit still and 
think of nothing is sometimes sufficient to induce the 
hypnotic state. The ordinary devices by 
which wakeful people are taught U) beguile sleep, by 
counting, or by repeating long lists of d 
belong to this category. Compulsory attention to any 
continuous intellectual process, like adding up 
umn of figures, or trying to read a dull book, is some- 
times effectual Tf. with theses or with similar acts of 
attention, be associated the expectation t 1 thing 

unusual is about to occur, as when the individual is 

awnro of being the subject of an experimi evolu- 

tion of the somnambulic condition i- greatly farili: 

Thus, one of the mosi recent meti agists in 

merely sitting, lor half an hour or more, with 

towards the patient. Attention, curiosity, and ex] 
tion. are thus excited, and a susceptible person 
begins to manifest some of the numerous and various 

forms of the hypnotic state. Heidenhain caused one of 
his students thus to go to sleep in broad daylight, by 
simply assuring him that he should hypnotise him from 
a distance at a particular hour of the afternoon. The 



HYPNOTISM. 217 

monks of Mt. Athos were accustomed to hypnotize 
themselves by fixing their eyes and their thoughts upon 
the navel ; hence the reputation of omphaloscopy as an 
aid to ecstatic meditation. 

The duration of hypnotic sleep is as variable as that 
of its prototype in natural somnambulism. The patient 
usually wakes spontaneously, after a few minutes or 
hours. Sometimes, however, the period of insensibility 
is greatly prolonged. If it be desirable to awaken the 
subject of experiment, a simple reversal of the move- 
ments by which sleep was induced may suffice. The 
paroxysm may be terminated by almost any sudden 
and energetic appeal to the senses, like an electric 
shock, a sudden illumination of the eye with vivid 
light, or a sharp puff of air upon the face. 

The simplest phenomena connected with the hyp- 
notic state are those transferences of cerebral percep- 
tions which have been investigated by the Society for 
Psychical Research. 1 Certain sensitive persons, when 
blindfolded, are capable of reproducing with consider- 
able accuracy visual images that have been impressed 
upon the mind of another. The sensitive subject is 
blindfolded and placed before a table with pencil and 
paper. Another person then goes out of the room, 
and gazes at some kind of drawing, geometrical figure, 
or other object selected without possibility of collusion 
with the subject of experiment. This person then 
returns to the room, and places his hand upon the head 
of the subject, at the same time fixing his attention 
upon the mental picture of the object. Presently the 
blindfolded subject takes the pencil and reproduces on 

1 Transactions of the Society, etc., Vols. I, II, III. 



218 INSOMNIA. 

paper a rough drawing of the object in question. In 
some cases it is found possible to effect this transfer of 
impressions without actual physical contact, — the agent 
merely standing behind the sensitive subject and con- 
centrating his thought upon the selected object. 
Closely akin to this is the method of muscle-reading, 
popularly known as mind-reading. The sensitive is 
blindfolded, and then presses against his forehead the 
hand of the person by whom he is to be guided. 
Almost immediately a tremor pervades his muscles, 
and he yields all his movements to the guiding influ- 
ence of the individual with whom he is in contact. If 
now an object be concealed in any place that is known 
to the agent, the concentration of that person's atten- 
tion upon the hiding place suffices to direct the " mind- 
reader," who immediately drags his companion to the 
given locality. 

The explanation of these phenomena consists in a 
recognition of the fact that certain persons are gifted 
with nervous organs which are sensitive and responsive 
to nervous impulses and muscular movements that are 
too delicate for recognition by the percipient appa- 
ratus of ordinary mankind. The more complicated 
forms of artificial somnambulism result from the com- 
plication and exaggeration of the results of this inor- 
dinate sensitiveness through the agency of artificial 
sleep. As in natural somnambulism, so in the hyp- 
notic state, certain organs become totally anaesthetic, 
while the sensibility of others is wonderfully exalted. 
Cutaneous sensation may be completely abolished, and 
the patient may become utterly insensible to every 
painful impression. The reflex functions may be 



HYPNOTISM. 219 

either suppressed or exaggerated, and the special 
senses of sight and hearing may be exalted to the 
highest degree. While in this condition the hyperaes- 
thetic condition of the brain renders the subject pecul- 
iarly susceptible to impressions from the will of 
another, so that all his actions are obedient to the 
guiding influence of the person under whose control 
he has passed. 

According to Charcot, 1 three principal types of arti- 
ficial somnambulism may be remarked among the 
hysterical subjects upon whom he experimented: (1) 
the cataleptic, (2) the lethargic, and (3) the somnam- 
bulic Of these the first may be developed primarily 
by any abrupt and powerful impression upon a sensory 
organ. Gazing upon a brilliant light, fixing the eyes 
upon a piece of polished metal, or upon the shining 
eyes of a second person, the sudden clangor of a Chi- 
nese gong, may suffice to induce the cataleptic state. 
Dumontpallier 8 reports the case of a young woman who 
accidentally hypnotized herself by gazing into the 
mirror before which she was dressing her hair. This 
cataleptic state may also be secondarily induced by 
merely opening the eyes of a patient in whom a condi- 
tion of hypnotic lethargy has been previously devel- 
oped. If only one eye be thus opened, the correspond- 
ing side of the body alone becomes cataleptic. Closing 
the eyes causes the disappearance of this symptom, 
with complete restoration of the purely lethargic state. 
During the cataleptic condition the several tendinous 
reflexes disappear, neuro-muscular hyper-excitability 

1 Le Progrh MJdical, Feb. 18, 1882, p. 124. 
9 Le Progrh Medical, March 25, 1882, p. 223. 



220 INSOMNIA. 

ceases, the skin becomes insensible, but the special 
senses, particularly those of sight and hearing, main- 
tain a partial activity. In this half-awakened state the 
senses may become avenues of suggestion from without 
for the production of movements ; but, if left to them- 
selves, the limbs remain motionless. 

The lethargic state may be induced by simply press- 
ing together the eyelids of the subject, or by causing 
him to fix his gaze upon some definite object. The 
paroxysm begins with a deep inspiration, causing a 
peculiar laryngeal sound, followed sometimes by the 
appearance of a little foam on the lips. The eyelids 
are either wholly or partially closed, and are in a state 
of continual tremulous motion. The eyeballs are 
generally turned upwards and inwards. The muscles 
are completely relaxed. The tendinous reflexes are 
exaggerated ; pressure over a muscle, or upon a nerve, 
arouses a peculiar contracture of synergic muscles and 
groups of muscles that are supplied by the excited 
nerve trunk. The facial muscles, however, do not thus 
become contractured ; they merely contract during ihe 
application of the stimulus. If the lethargic subject 
be rendered cataleptic by opening the eyes, these con- 
tractures persist even after waking ; and they can only 
be dispelled by renewing the lethargic state before 
resorting to pressure upon the antagonistic muscles — 
the process by which contractures peculiar to this spe- 
cies of lethargy may always be annulled. By the 
approach of a magnet to a contractured limb, the 
rigidity may be completely transferred to the corre- 
sponding muscles upon the opposite side of the body. If 
upon a limb of a lethargic subject who has been ren- 



HYPNOTISM 221 

dered cataleptic by opening the eyes, an Esmarch's 
band be applied, pressure over the bloodless muscles 
excites no contracture until the band is removed. A 
contracture is then developed, and it may be trans- 
ferred to the opposite limb by the approach of a 
magnet. To this phenomenon has been applied the term 
latent contracture. 

The extraordinary muscular excitability manifested 
by these subjects is further illustrated by an observa- 
tion recorded by Dumontpallier. 1 If one end of an 
India rubber tube, half an inch in diameter, and five 
or six yards in length, be applied over a muscle in the 
leg, and if the other end be in like manner connected 
with a watch, every movement of the second hand will 
be followed by a slight contraction in the muscle. The 
same result follows connection with the wire of a tele- 
phone: and, if a microphone be introduced into the 
circuit, tin* incidence of a ray of light upon the instru- 
ment, or even its reflection from the conjunctival 
surface of the eye of a spectator, will arouse a respon- 
sive muscular contraction. Charcot has also seen mus- 
cular motion upon the opposite side of the body when 
a mild galvanic current was applied to the parietal 
surface of the skull, presumably over the motor centres 
of the corresponding half of the brain. 

During these manifestations of muscular hyper- 
excitability, there is complete insensibility to pain, but 
the senses of sight and hearing seem to preserve some 
degree of activity. The subject, however, does not 
often exhibit any susceptibility to influence by sug- 
gestion. 

1 /> Progris Medical, Jan. 14, 1882, p. 25. 



222 INSOMNIA. 

The somnambulic state may be directly induced by 
fixed attention with the eyes, by feeble and monoto- 
nous excitement of the senses, by passing the hands 
over the face and arms of the subject, and by many 
other processes of analogous character. This variety 
constitutes the ordinary form of hypnotic sleep. It 
may be very easily developed during either the leth- 
argic or the cataleptic state as a consequence of 
pressure or of gentle friction upon the top of the 
head. Thus Heidenhain, in the course of his experi- 
ments, caused muscular paralysis by rubbing the scalp. 
Friction of one side of the head occasioned paralysis 
of the opposite side of the body without notable affec- 
tion of the consciousness of the subject. The eyes and 
the eyelids behave as in the lethargic state. The sub- 
ject seems to be asleep, but there is less muscular 
relaxation than in the lethargic variety. There is no 
exaggeration of the tendinous reflexes, and muscular 
hyper-excitability is absent. But by lightly touching 
or breathing upon the surface of a limb, its muscles 
may be thrdwn into a condition of rigidity which 
differs from the contracture of the lethargic state, in 
the fact that it does not yield to excitement of the 
antagonistic muscles, though yielding readily to a 
sudden repetition of the same form of excitement by 
which it was originally produced. Thus a subject 
under my own observation who, by pressure upon the 
eyeballs, was rendered insensible to every form of 
painful stimulation, would immediately pass into a 
state of perfect rigidity, if his limbs and body were 
rubbed for a few seconds with the palm of the hand. 
While in this condition, if the heels were placed upon 



HYPNOTISM. 223 

a chair and the back of the head upon another, not 
only could the entire weight of the body be thus sup- 
ported, but also the additional weight of another full- 
grown man, sitting upon his body, without causing any 
more yielding than if it had been a log of wood that 
was lying across the chairs. From the immobility of 
the cataleptic state this rigidity differs by its greater 
d< -i^ree of resistance to passive motion. Though insen- 
sibility to pain may be perfectly developed in this state, 
there is generally an exalted condition of certain forms 
of cutaneous sensibility, and of the muscular sense. 
Strange perversions of other special senses are some- 
times remarked. Thus, Cohn 1 discovered that a patient 
who was naturally color-blind, was able, when unilat- 
erally -hypnotized, "to distinguish colors which were 
otherwise uiulistinguishable." Conversely, when the 

deptio state is induced, the healthy eye becomes 
incapable of discerning colors. Spasm of accommoda- 
tion is also present, and is one of the earliest demon- 
strable symptoms of the hypnotic condition. 

These remarkable exaggerations and perversions of 
sensibility have been the cause on the one hand, of 
much skepticism regarding the verity of the phe- 
nomena of hypnotism, and, on the other, of much 
credulity, extending even to a belief in the existence 
of supernatural and miraculous powers. The extra- 
ordinary character of these experiences is well illus- 
trated by the following letter from Lieut. J. M. Brooke, 
of the United States Navy, to President Wayland, of 
Brown University. It may be found in "Wayland's 
Intellectual Philosophy." 

1 Brain, Vol. Ill, p. 394- 



224 INSOMNIA. 

"Washington, Oct. 27th, 1851. 

"Sir — It affords me pleasure to comply with your request, made 
through my brother William, relative to some experiments performed on 
board the United States steamer ' Princeton,' in the latter part of the 
year 1847, she being then on a cruise in the Mediterranean. Nathaniel 
Bishop, the subject of the experiments, was a mulatto, about twenty-six 
years of age, in good health , but of an excitable disposition. The first 
experiment was of the magnetic or mesmeric sleep, which overpowered 
him in thirty minutes from the commencement of the passes made in the 
ordinary way, accompanied with a steadfast gaze and effort of the will 
that he should sleep. 

"In this state he was insensible to all voices but mine, unless I 
directed or willed him to hear others; he was also insensible to such 
amount of pain as one might inflict without injur}', that is, what would have 
been pain to another. He would obey my directions to whistle, dance or 
sing. When aroused from this sleep he had no recollection of what 
occurred while in it. That such an influence could be exerted, I was 
already aware, having previously witnessed satisfactory experiments. Of 
clairvoyance I had never been convinced; indeed, considered it nothing 
but a sort of dreaming produced by the will of the operator. I became 
aware of its truth rather through accident than design. 

1 ' It happened, one day, that some of my brother officers asked a 
question which the others could not answer. Bishop, who had been a 
few moments before in a mesmeric sleep, gave the desired information, 
speaking with confidence and apparent accuracy. As the information 
related to something which it seemed almost impossible to know without 
seeing, we were very much surprised. It struck me that he might be 
clairvoyant; and I at once asked him to tell me the time by a watch kept 
in the binnacle, on the spar or upper deck, we being on the berth or lower 
deck. He answered correctly, as I found upon looking at the watch, 
allowing eight or nine seconds for time occupied in getting on deck. I 
then asked him many questions with regard to objects at a distance, 
which he answered, and, as far as I could ascertain, correctly. 

" For example, one evening, while at anchor in the port of Genoa, 
the captain was on shore. I asked Bishop, in the presence of several 
officers, where the captain then was. He replied, ' At the opera with 
Mr. Lester, the consul.' ' What does he say? ' I inquired. Bishop 
appeared to listen, and in a moment replied: ' The captain tells Mr. 
Lester that he was much pleased with the port of Xavia; that the authori- 
ties treated him with much consideration.' Upon this, one of the officers 
laughed, and said that when the captain returned he would ask him. He 
did so, saying, ' Captain, we have been listening to your conversation 



HYPNOTISM. 225 

while on shore.' 'Very well,' remarked the captain, 'what did I say?' 
expecting some jest. Then the officer repeated what the captain had said 
of Xavia and its authorities. ' Ah,' said the captain, ' who was at the 
opera? I did not see any of the officers there.' The lieutenant then 
explained the matter. The captain confirmed its truth, and seemed much 
surprised, as there had been no other communication with the shore dur- 
ing the evening. I may remark that we touched at several ports between 
Xavia and Genoa. 

" On another occasion, an officer being on shore, I directed Bishop 
to examine his pockets; he made several motions with his hands, as if 
actually drawing something from the officer's pockets, saying, ' Here is a 
handkerchief and a box; what a curious thing! full of little white sticks 
with blue ends. What are they, Mr. Brooke? ' I replied, ' Perhaps they 
are matches." ' So they are,' he exclaimed. My companion, expecting 
the officer mentioned, went on deck, and meeting him at the gangway, 
asked, ' What have you in your pockets? ' ' Nothing,' he replied. 'But 
have you not a box of matches?' 'Oh, yes' ' said he. ' How did you 
know it? I bought them just before I came on board. The matches 
are peculiar, made of white wax with blue ends.' 

" The surgeons of the ' Princeton ' ridiculed these experiments, upon 
which I requested one of them (Farquharson) to test for himself, which 
he consented to do. With some care he placed Bishop and myself in one 
corner of the apartment, and then took a position some ten feet distant, 
concealing between his hands a watch, the l«ng hand of which traversed 
the dial. He first asked for a description of the watch. To which 
Bishop replied, "Tis a funny watch, the second hand jumps.' 

" The doctor then asked him to tell the minute and second, which 
he did; directly afterwards exclaiming, ' The second hand has stopped! ' 
which was the case, Dr. Farquharson having stopped it. ' Well,' said 
the doctor, ' to what second does it point, and to what hour, and what 
minute is it now? ' Bishop answered correctly, adding, ' 'Tis going 
again.' He then told twice in succession the minute and second. 

" The doctor was convinced, saying that it was contrary to reason, 
but he must believe. I then proposed that the doctor should mark; and 
directed Bishop to look in his mother's house, in Lancaster, Pa., (where 
he had never been) for a clock; he said there was one, and told the time 
by it; one of the officers calculated the difference in time for the longi- 
tudes of Lancaster and Genoa, and the clock was found to agree within 
five minutes of the watch time." 

Such clairvoyance is very rare ; in fact, it is difficult, 
at first thought, to believe in its existence. Nor should 

15 



226 INSOMNIA. 

its alleged possession be credited in any instance until 
all possibility of deception has been excluded. The 
example just related seems to be, in this respect, one 
of the best, for the reason of its occurrence in a little 
group of men whose isolation and thorough acquaint- 
ance with each other must have reduced the chances of 
simulation to the lowest degree. When carefully con- 
sidered, moreover, it is apparent that the exaltation of 
the functions of sight and of hearing in this case was 
not different in kind or in degree from that that has 
already been recorded in connection with certain cases 
of natural somnambulism and of dreaming. The con- 
dition of the brain is probably identical in all such 
instances ; it is the mode of its induction that is subject 
to variation. The remarkable feature of the hypnotic 
state consists in its production at the pleasure of either 
the subject or of the agent under whose control he has 
passed; whereas the phenomena of natural somnam- 
bulism and of the clairvoyant dream occur only during 
sleep, and independently of the will of the patient. 

Another singular fact in this connection is the 
receptivity of the hypnotized brain for suggestions 
from the minds of other persons. Usually, the patient 
is insensible to all communications which do not 
emanate from the agent by whom he is held in control : 
but in certain cases it is probable that the brain is 
more or less open to impressions of a particular sort 
from any source. Numerous examples illustrate the 
manner in which the course of an ordinary dream may 
be thus directed. The hypnotic dream is far more 
easily modified by suggestions from without. The 
simplest examples of this are exhibited by the hypno- 



HYPNOTISM. 227 

tized subject who walks, jumps, lies down, executes 
every variety of pantomime, in obedience to the com- 
mands of his director. Somewhat more complicated 
are the actions that are developed through excitement 
of the imitative faculties. Every movement of the 
director lltaf can be perceived by ihe subject will be at 
once reproduced. Dr. Fischer relates ' the case of a 
patient who. although exceedingly ignorant of the art 
of music, was able, during the hypnotic paroxysm, to 
EOXlg with Jenny Lind all kinds of songs, so accurately 
that it was impossible to distinguish their separate 
voices. Expression of the various emotions and pas- 
sions may also be provoked by merely placing the 
subject in the several attitudes characteristic of such 

feelli 

In the Lower grades of the hypnotic state, con- 
sciousnese Lb aot abolished, and the subsequent recol- 
lect ion of events during the experience may be quite 
perfect In Buch eases illusions and hallucinations, that 
were excited by suggestions from the controlling mind 
of another, survive in memory, and become the causes 
of serious delusion. Witness, for example, the manner 
in which exeitable people, partially hypnotized in a so- 
oalled "spiritual circle." believe in the reality of the 
illusions which have occupied their powers of percep- 
tion during a "seance." To this inferior grade of self- 
induced hypnotism belong all those conditions of 
sensory hyperesthesia by means of which certain per- 
EM -ns are enabled to read the hidden thoughts of others. 
This capacity is, essentially, a mere exaltation of that 
power which all mankind shares in a greater or less 

1 Op. cit., p. iS. 



228 INSOMNIA. 

degree. In every instance it has been remarked that 
the ordinary "medium" can only respond correctly to 
questions for which the true answer is present in the 
mind of the questioner. To all other interrogatories 
the replies are delivered purely under the influence of 
random suggestion. In some cases the pathway of 
communication lies through actual bodily contact, as 
in ordinary " mind-reading," where the invisible 
molecular oscillations of the muscular elements of one 
person serve to guide the perceptions and movements 
of another. But, more frequently, the transmission of 
ideas is effected through the action of the facial and 
ocular muscles. From these organs of expression the 
"table-rapper," or the " planchette-writer," reads the 
unspoken thoughts of the questioner, in a manner very 
like, yet vastly more delicate than that by which deaf 
mutes are taught to interpret the movements of the lips 
of persons with whom they converse. This fact is 
clearly illustrated by the experience of Maury, 1 in an 
interview with a celebrated table-rapper who, without 
the slightest hesitation, made known to him the age, 
name, and date of death of a brother whom he had 
lost. She also gave the same information regarding 
his father, and pronounced the names of other persons 
upon whom he had fixed his attention. But. if he 
turned away his face, or if he concealed his eyes so 
that the woman could no longer scrutinize their expres- 
sion, her responses became entirely uncertain and 
destitute of conformity with fact. 

The induction of the hypnotic state, if not too often 
repeated, is sometimes of considerable service in the 

1 Le Sommeil ct Ies Reves, p. 361. 



HYPNOTISM. 229 

relief of various functional disorders of a painful 
character. This fact, enthusiastically announced, 
many years ago, by Dr. Braid, has recently been 
freshly brought forward through the experiments of 
Fischer. 1 Wiehe, 1 Rieger, 3 and others. In our own 
country this method of treatment has not yet been 
adopted by many in the medical profession, though its 
efficacy in a particular class of cases is not denied. 
( tatside of professional circles, however, it is exploited 
to a considerable extent under the strange misnomer 
of Metaphysical Healing. But, as De Watteville has 
truly remarked/ "the time is near when the curative 
influence of hypnotism will be submitted to the same 
scrutiny as its physiological and psychological import 
has undergone." 

. <•//. 

9 Berlin. Klin. IVocJunschr, January, 18S4. 
■ Der Hypnotismits, Jena, 1SS4. 
4 Brain, July, 1SS4, p. 278. 



THE END. 



INDEX. 



Adds _ 

hydrobromlc .._[ 

hydrochloric .... 

byd _'" 

hw 

■ic 

nit • \ 

nltn. muriatic, In hepatic i 



phosphoric 



Afrl 
winds from the . feci of, 

victims of tbe maladle da 
moll 

**""]_ 

•fleet of, upon the brain 

In •' rll 

In asthma 

in ehoree 

in dyspepsia 

in terer 

in b< 

. Prof. .1. Ad. mi-, case <>f som- 
nambulism observed by 
Aiii\. •:- of, regarding 

temperature in Ble 
AUIx ami ii i ilons of, re- 
garding the pulse in Bleep 

- in insanity 

Ammonia, in fever 

nitrite 

In angina pectoris 

In asthma 

in of the brain 



irs, delusions regarding, 



Antl-spasmodlc effects of be la- 

donna 

Apparent death 

crucial test of 

Arabia, effects of wind from the 

deserts, of 

Arago, observations of, regarding at- 

mospberlc electricity 

Ic, In asthma 

Atrnpla 

Atropine, use of, with opiates 



71 
100 

ioa 



io.; 

1111) 

U 

46 

40 

30 

;<; 

54 
99 

101 

Hit 
108 
103 
102 



Artificial sleep, effect of, upon the 

process of oxidation 9 

modeof production of \'_ 22 

Artificial somnambulism .'.".". 214 

cataleptic form of ""_" 219 

lethargic form of 220 

recollection of the events of 227 

somnambulic form of 222 

three varieties of 219 

ida. use of, in insomnia no 

Assimilation, rate of, in sleep 5 

Association of ideas, cessation of, in 

sleep. 3 

effect of 123 

Asphyxia 100 

Asthma, insomnia caused by 101 

relieved by atropine 69 

relieved by chloroform 82 

relieved by ether 82 

relieved by iodide of potassium... 110 

relieved by lobelia 71 

relieved by stramonium 71 

relieved by tobacco 71 

Atmospheric electricity, effects of.. 46 
Australia, effect of winds from the 

deserts of 46 

Axam, a case of somnambulic life ob- 
served by 208 

Bachelder, Dr G. EL, observations of, 

on the maladie du sommeil 32 

Balllarger, hallucination excited by 

dreaming 126 

Ball and Chambard, classification of 

the varieties of somnambulism . 169 
Baths, use of. as nervous stimulants, 60 

cold 73, 95 

in fever 104 

in insomnia 112 

In scarlet fever 76 

shower 95 

warm .: .- 94 

Bartholow, on the use of phosphorus, 71 
Beard and Rockwell, on the use of 

electricity 62 

Beer, effect of 76 

Belladonna 69, 100 

use of, In asthma 101 

use of, in fever 104 

use of, in hepatic diseases 102 

Bismuth, use of, in gastric diseases. 103 



232 



INSOMNIA. 



Page. 
Bladder, insomnia in irritability of.. 90 

Blisters, use of, in rheumatism 106 

Blood, control of its circulation by 

the nervous system 26 

Bombardment, sleep during... 1 

Boussingault, experiments of, on 
the process of oxidation in the 

tissues .- 9 

observations of, on respiration in 

sleep 6 

observations of, regarding the 

bodily temperature in sleep 7 

Brain, consequences of inordinate 

excitability of 159, 161 

exalted receptivity of, during the 

waking state 150 

exalted susceptibility of, in sleep 

and dreaming 144, 130 

the, its division into separate 

mechanisms 13 

the, a reservoir of sensory im- 
pressions 124 

Brandy, use of, In wakefulness 77 

Bromide of potassium, use of, in 

insanity 95 

of sodium, use of, in chronic alco- 
holism 97 

of sodium, use of, in delir.uin 

tremens N 

Bromides, the s^ 

use of, in convulsions llo 

use of, in delirium 77 

use of. in fever 104 

use of, In night terrors US 

use of, in pregnancy, and after 

parturition 109 

use of, with chloral and morpi 
Brooke, Lieut. J. M., observations 
of, regarding hypnotic clairvoy- 
ance 

Bronchitis, insomnia noosed by 100 

insomnia of, relieved with paral- 
dehyde 80 

Brunton, Dr. T. Lauder, his theory 

of counter-irritation 62 

Butylchloral hydrate M 

Ruschiek, experience of, in waking 

before earthquakes 144 

Caffeine, effect of, upon the brain. 54 

Camphor - li ^ 

use of, in asphyxia - 100 

use Of, in fevers.. 105 

use of, in the insomnia of cach- 
exia - 1«8 

use of, after parturition 109 

Cannabln.. - W 

Cannabln tannate 58 

Cannabis Indlca fi ^ 

anti-aphrodisiac effect of... 59 

use of, in delirium tremens 98 

use of, in fever 104 

use of, in insanity 96, 97 

use of, in pregnancy 109 

use of, as a substitute for hyos- 

cyamus - US 

Cantharides 63 

Capsicum 6S 



Page. 

Capsicum, use of, in the insomnia of 

delirium tremens 77, 98 

Carbolic acid, vapor of, for relief of 

cough 100 

Carbon, oxidation of, during sleep. 7 
Carbonic acid gas, discharge of, 

during sleep 9 

Cardiac debility, use of butylchioral 

In 83 

Cardiac disease, insomnia of, treated 

with paraldehyde 80 

treated with digitalis 66 

Cardiac dyspnoea, relieved with opi- 
ates 87, 98 

Cardiac neuralgia 99 

Carotid arteries, compression of, for 

relief of insomnia 25,27. 57 

Cataleptic form of artificial som- 
nambulism 219 

Catarrh, nasal, effect of sleep upon. 8 
Catou, Judge John D., on the diffi- 
culty of Bleep during the con- 
tinuous daylight of summer in 

Norway 40 

Cerebral activity, effect of, upon 

bodily temperature 8 

Cerebral anaemia and its cause dur- 
ing sleep - 

use of phosphorus for 71 

Cerebral circulation, dependence of 

consciousness upon 25, 27 

durin- • vat ions upon, by 

Prof. 26 

Cerebral exhaustion, benefited by 

the use of phosphorus 71 

in fever 10S 

Cerebral hyperemia, effects of 145 

insomnia of, treatment with paral- 
dehyde 80 

Cerebral irritation in cachectic states 108 
Cerebro-spinal meningitis, use of 

opiates in 93 

Cerebro-spinal weakness 110 

Change of life, use of valerian dur- 
ing --- 6S 

Chicago, embarkation from 45 

the great fire In 40 

Child-birth, insomnia after 

Chi ral 

Chloral hydrate, influence of, upon 

oxidation in the tissues 9 

association of, with morphia and 

bromides 86 

use of, in angina pectoris 99 

use of, In asthma 101 

nae of, in cachexias with insom- 

109 

use of, in chorea HO 

use of, in chronic alcoholism 97 

use of, in delirium tremens 98 

use of, in fevers 104 

use of, in hepatic diseases 102 

. In insanity 

use of, In meningitis 94 

use of. in night terrors US 

use of, in respiratory d 
Chlorodyne 



INDEX. 



233 



Page. 
Chlorodyne, use of, in syphilitic neu- 
ralgia 107 

Chloroform SI 

use of, In asthma 101 

use of, in convulsions no 

spirit of, In the treatment of 

fivers. 105 

Chossat, observations of, on the tem- 
perature of pigeons 7 

Circulation of blood, its regulation 

by tin- nenrooi system 88 

disorders of 52 

modified by counter-irritation 65 

of, during sleep 6 

Clairvoyance, hypothetical explana- 
tion of 148 

in dream* 146,148, 14<> 

In dreaming, and in natural som- 
nambulism 

in the hypnotic btate 224 

Clark, observations of, on the Bleep- 
ing dropsy 30 

85 

Codeine 8S 

Coffee, effects of, upon tlie brain 54 

Cold, a nervous sedative 73 

Cold baths... 73 

Cold, excessive, a cause Of stupor... 47 

Colic, uterine, relief of 81 

Color -blindness, effect of hypnotism 

upon 223 

Coma 32 

Conllne 91 

Conlum 90. 95 

-», duration of the sensa- 
tions required for Its excitement 23 

of , daring sleep 14 

Convulsions, excited by compression 

of the carotid arteries 27 

treatment of 110 

Cough, spasmodic, treatment with 

spirit of chloroform 82 

Counter irritants 62 

Crotonoil 63 

Cups, counter irritation with 63, 93 

Curci, observations of, regarding 

belladonna 69 

ling morphia 85 

Cutaneous disorders, causes of in- 
somnia 55 

DaCosta, on lithtemia 106 

Darkness, favorable to sleep 18 

Day and night, alternation of, a cause 

eep l" 

Death, apparent 34 

: 35 

ration of the brain 55 

Demxne, observations of, on bodily 

temperature in sleep 7 

Delirium 54 

excited by hyoscyainus 70 

excited by stramonium 71 

of exhaustion ~~ 

treatment of, with musk 67 

Delirium tremens, treatment of, 

with alcohol "i~ 

xvifh hrnmlrtPS . 89 



Page. 
Delirium tremens, treatment of, 

with capsicum 77 

with chloral 82 

with digitalis 1__ 67 

Delusions, caused by dreams [ 128 

Depressing emotions, a cause of sleep 19 
Diagram, illustrating the stages of 

sleep 4 

the varieties of somnambulism 172 

Digitalis, indirectly hypnotic effect 

of 66 

treatment of delirium tremens with 98 
Diminution of energy, represented 

by sleepiness % 

Disease and dissolution, revival of 

memory in 165 

Dover's powder 67, 100, 104, 110, 112 

Double consciousness .204, 206 

Dreams n6 

analysis of 133 

at the moment of waking 14 

brevity of 15 

causes of 118 

cause of special vividness of 134 

clairvoyant 146,148, 149 

coherence of 131 

definition of 120 

dependence of, upon partial sleep 

of the brain n 

duration of 135 

excited by gustatory sensation, 

43, 125, 130 

by heat 43 

by painful diseases 141 

by sensory impressions during sleep 29 

by sounds 41 

incoherence of... 133 

intellectual combinations in 131 

mode of their production.. 124 

primitive belief in the divine ori- 
gin of 160 

prophetic 142, 143 

recollection of 140 

relation of, to depth of sleep 4 

relation of, to waking hallucina- 
tions , 126 

resemblance of, to the mental pro- 
cesses of insanity 133 

revival of memory in 162 

somnambulic 178 

state of volition during 141 

suggested by externalimpulses. 125, 130' 

theory of 116 

waking 123 

Dropsy, treatment of, with digitalis. 66 
Dumontpallier, case of self-hypno- 
tism related by 219 

Duration of sleep 110 

Dyspnoea, cardiac 98 

treatment of, with digitalis 66 

Dyspeptic insomnia 104 

East Indies, climate of, a cause of 

insomnia - 44 

Eggs, as an article of food 66 

Electrical test of apparent death 35 

Electricity, atmospheric 46 

use of 62, 63 



234 



INSOMNIA. 



Page. 
Emphysema, insomnia of, relieved 

with paraldehyde 80 

Energy, diminution of, represented 

by sleepiness 2 

renewal of , by sleep 5 

Epilepsy, double consciousness in... 205 

Ether, hypnotic effect of 81 

inhalation of 9S 

use of , in asthma 101 

use of, in convulsions 110 

use of, in irritative cough 100 

Ether, compound spirit of SI 

use of, in delirium tremens 98 

use of, in hepatic diseases 102 

Excrementltious substances, causes 

of insomnia 55 

Exhaustion, a cause of sleep 19 

relief of with alcoholic stimulants. 76 

states of 64 

use of musk in 63 

Exner, experiments of, to test the 

possibility of dreamless sleep. .. 14 
Eye, state of its secretions during 

sleep 8 

Facial neuralgia, treatment of, with 

butylchoral 83 

Fainting, a counterfeit of sleep 25 

Fatigue, a cause of sleep .. 19 

Fatigue theory of sleep 20 

Fevers, eruptive, treatment of with 

musk 68 

infective 57 

typhoid 57 

treatment of with cold baths 73 

Flaxseed tea 100 

Florida, climate of, in insomnia 114 

Fonssagrives, observations of, re- 
garding atmospheric electricity 

and insomnia 46 

Food, lack of, a cause of insomnia.. 63 
Foot-baths, hot, in the treatment of 

Insomnia 93, 94 

Force, fluctuations of 15 

kinetic 15 

potential 15 

Frank, J. P., case of somnambulism 

related by 195 

Functional nervous disorders, treat- 
ment of with hypnotism 229 

Gairdner, W. T., case of somnambu- 
lic lethargy reported by 174 

Gastro-intestinal glands, state of 
their secretions during sleep- 

Gelsemium 90 

treatment of fever with 104 

use of, in the wakefulness of chil- 
dren 112 

Generation of ideas, relation of, to 
inolecular movements In the 

brain - "24 

Grasset, case of somnambulism re- 
lated by 177 

Guerin, observations of, on the mala- 

die du sommeil 30 

Guiana, delusions among the Indians 

of, founded upon dreams 12$ 

travelsln 42 



Pagb. 
Guy, observations of, regarding the 

pulse in sleep 7 

Hallucination, case of, related by Dr. 

E. H. Clarke 156 

experienced by Sir Edmund Horn- 
by 150 

production of, by drugs 120 

sometimes excited by dreams. 126, 150 
Hamilton, Sir William, experiments 
of, on the possibility of dreamless 

sleep 14 

Hasheesh, visions excited by 120 

Hayes, Dr. P. S , case of lucid leth- 
argy reported by 35 

Headache 54 

Hearing, persistence of during sleep, 41 

sense of, during sleep 11 

Heat, a cause of insomnia 44 

a nervous stimulant 59 

effects of excessive 47 

liberation of, during sleep 9 

Heart, pulsation of, in sleep 6 

Heldenhain, observations of, on hyp- 
notism 214 

Helmholtz, observations of, on lib- 
eration of heat during sleep 9 

Hemicrania, treatment of,wlth butyl- 
chloral 83 

Henneberg, experiments of, on oxi- 
dation in the tissues 9 

Hibernation, phenomena of 43 

Hoffmann's anodyne 81 

Hohl and Allix, observations of, on 

the pulse in sleep 6 

Holland, Sir Henry, observations of, 
regarding the loss of memory 

during exhaustion 209 

Hops 90 

treatment of chronic alcoholism 

with 97 

Hornby. Sir Edmund, experience 

of hallucination 150 

Horsf ord's Acid Phosphate 72 

Horvath, observations of, on the tem- 
perature of hibernating mar- 
mots 8 

Hunger 2 

Hydrobromic acid 

Hydrochloric acid, useful in atonic 

dyspepsia 

Hydrocyanic acid 100 

in gastric diseases _ 103 

Hyosciamia 70. 9«i 

H yosc iamine 70 

Hyoseyamus 7 > 

use of. after parturition 

use of, in asthma 101 

use of. in fever 104 

use of. in hepatic diseases 102 

use of. in insanity 9o 

use of, in insomnia of children 112 

use of. in renal diseases 102 

Hyperemia of the brain 52. 54, 110 

Hypnagogic hallucinations 

Hypnagogic state I 

Hypnotic sletp, duration of 

Hypnotic sleep, clairvoyance in . 



INDEX. 



235 



Page. 
Hypnotic sleep, condition of the 

special senses in 223 

conditions favorable to 214 

exaltation of the imitative faculty 

during 227 

methods of inducing 215 

perception during 149 

Hypnotism 214 

liken* .lambulism 2u3 

observations of Braid 214, 229 

observations of Charcot. .214, 319, 221 

observations of (John 223 

observations of De Watteville 229 

observations of Dumontpallier.219, 221 

observations of Fischer 150, 227 

observations of Harting 215 

observations of He.denhain, 214. 

315, 216, 222 
observations of Milne-Edwards... 215 

observations of Kieger 229 

observations of Wiehfl 339 

tlvlty of the brain to suc- 
tions during.. . _ 

suggestion of ideas during 226 

therapeutical use of 228 

double conscious- 
ness 306 

Hysterical excitement, treatment of. 68 
\ in the treatment of acute 

:itTi.rloiis of the brain 93 

Iceland BUMS, for the relief of cough, 100 
their dependence upon mole- 
cular movements in the brain.. 24 
Illusions, excited by disease and by 

drugs 120, 122 

Imagination, pers:s:ence of, in sleep, 3 
Imitative faculties, exaltation of, in 

hypnotic states 227 

Immermann, on cold baths 73 

Impulses to violence during som- 
nambulism 193 

Im Thorn, Brerard F., on dreams 

among the Indians of Guiana 128 

Indians, of Guiana, magic practices 

among 42 

Inflammations affecting the brain... 54 

Inhalations, medicated 100 

Injuries of the brain 55 

Insanity 54, 57, 70, 133 

Insomnia 38 

Insomnia, causes of 39 

1 by aortic obstruction 84 

: by asthma 101 

l by cardiac disorders 51 

caused by cold 47 

I by contagia of animal ori- 
gin 55 

caused by cutaneous disorders. 49, 55 

1 by dyspepsia 51 

censed by electrical disturbances. 46 
caused by excrementitious sub- 
stances. 55 

caused by fatigue 78 

caused by heat 44, 46 

caused by heat and humidity 44 

caused bj icterus 49 



Pa.gk. 

Insomnia, caused by inflammations. 50 

caused by insects 49 

caused by itching in myelitis -.... 49 

caused by itch-mite 49 

caused by light 39 

caused by malaria 72 

caused by meningitis 50 

caused by miasms 55 

caused by morbid states of the cen- 
tral nervous organs 51 

caused by neuralgia 50 

caused by neuritis 50 

caused by neuromata 50 

caused by oxaluria 72 

caused by pain 49 

caused by parasites 49 

ciused by periostitis 50 

caused by phosphatic diathesis 72 

caused by pneumogastric disorder. 51 

caused by poisons 55 

caused by products of putrefac- 
tion 55 

caused by respiratory disorders... 51 

caused by rheumatic diathesis 72 

caused by sounds 41 

caused by smells 42 

caused by stramonium 71 

caused by sympathetic nerve dis- 
order 50 

Insomnia, occurrence of, after child- 
birth 81 

occurrence of, after parturition... 109 
occurrence of, during acute affec- 
tions of the brain 92 

occurrence of, during bronchitis.. 80 
occurrence of, during cardiac dis- 
eases ...66,80, 87 

occurrence of, during change of 

life in women 84 

occurrence of, during childhood... 110 

occurrence of, during chorea 110 

occurrence of, during chronic alco- 
holism 97 

occurrence of, during chronic 

phthisis ... 84 

occurrence of, during delirium 

tremens ...87, 90, 97 

occurrence of, during diseases of 

the heart and blood-vessels 98 

occurrence of, during diseases of 

the liver 102 

occurrence of, during diseases of 

the respiratory organs 99 

occurrence of, during disorders of 

nutrition 107 

occurrence of, during dysmenor- 

rhoea ._- 84 

occurrence of, during emphysema, 80 
occurrence of, during febrile con- 
ditions and fevers 87, 104 

occurrence of, during gastric and 

intestinal disorders 87, 103 

occurrence of, during gout and 

rheumatism 103, 107 

occurrence of, during headache.. 84 

occurrence of, during hysteria. 81, 89 



236 



INSOMNIA. 



Page. 
Insomnia, occurrence of, during in- 
sanity 94 

occurrence of, during irritability of 

the bladder 90 

occurrence of, during irritability of 

the sexual organs 90 

occurrence of, during irritative 

dyspepsia 90 

occurrence of, during jaundice 80 

occurrence of , during lithaemia, 106, 107 
occurrence of, during mania, 87, 89, 90 
occurrence of, during melancholia, 96 
occurrence of, during mental ex- 
haustion 89 

occurrence of, during nervous dis- 
orders 80 

occurrence of, during neuralgia... 84 
occurrence of, during old age. .78, 113 
occurrence of, during opium habit, 84 
occurrence of, during paretic de- 
mentia 96 

occurrence of, during phthisis.. 80, 87 
occurrence of,durlng pregnancy. s:>, in.i 
occurrence of, during the puerperal 

state 89 

occurrence of, during renal dis- 
eases 101 

occurrence of, during rheumatism 

and gout 105, 107 

occurrence of, during sexual excite- 
ment 89 

occurrence of, during spasmodic 

diseases 109 

occurrence of, during states of ex- 
haustion 67 

occurrence of, during syphilis. 106, 107 
Insomnia, relation of, to states of 

the cerebral circulation 57 

relief of, by compression of the 

carotid arteries 26 

Iodide of potassium, treatment of 

asthma with .-. 110 

Ipecac, treatment of asthma with... 101 

Irritability of the brain 53, 54 

Itching of eczema, relieved with can- 
nabis indiea 69 

Jacobi, A., on wakefulness of chil- 
dren Ill 

Japanese, use of massage among 61 

Jaundice, insomnia of, treatment 

with paraldehyde 80 

Jessen, ease of hallucination caused 

by dreaming 12? 

Joseph, St., dreams of 142, 160 

Judgment, suspension of, during 

sleep - 3 

Kohlschiitter, experiments of, to 

measure the depth of sleep 16 

Koumiss : 64 

Lactic acid, hypnotic effects of 72 

Lactate of sodium, hypnotic effects 

of 80, 72 

Lactucarium --- SS 

Latent contracture 821 

Leeches, use of 63, 93, 94 

Lethargic form of artificial somnam- 
bulism 220 



Page. 
Lethargy 33 

produced by excessive cold 48 

Lewin, observations of, on respira- 
tion during sleep 6 

experiments of, on oxidation in 

the tissues 9 

Llebermeister. experiments of, on ox- 
idation in the tissues 9 

Life, normal 4 

possibility of intermissions in its 

active manifestation 15 

Light, interfe.ence of, with sleep,40, 41 

Liquors, effects of 76 

Lithaemia, a cause of insomnia 106 

Lithium bromide 88 

Lobelia, anti-spasmodic effects of, 71, 101 

Loini-lomi 61 

Lucid lethargy 35 

contrasted wirh somnambulic leth- 
argy 176 

Lupulin 90 

Macario, case of somnambulism, 

reported by . 192 

Mackinac, voyage to 45 

liacoish, case of somnambulic life, 

reported by 206 

Maladie du sommeil 

Malaria, treatment of insomnia, 

caused by 72 

Mania, use of chloral in 82 

Marmot, hibernation of 48 

temperature of, during hiberna- 
tion 8 

60, 109 

Matter and mind, communication 

between , 

Maury. A., classification of the vari- 
eties of somnambulism 16S 

experience of, with table-rap; 
theory of, regarding forgetfulness 
of the events of somnambulism. 211 

Measles, use of baths in .. 74 

Meat juice 66 

Memory, effect of physical exhaus- 
tion 209 

exaltation of, in somnambulism... 1S7 

persistence of, in sleep 3 

relation of, to phenomena of som- 
nambulism 192 

revival of. during disease and dis- 
solution 165 

revival of, during dreaming 162 

Meningitis 

Mental activity during sleep 14 

Mesnet, case of somnambulism re- 
lated by 196 

Metaphysical healing 829 

Michigan, Lake, voyage upon. 45 

Northern, summer climate of, 

favorable to sleep 45 

Milk, peptonized 64 

Mind and matter, communication be- 
tween 22 

alternate states of action and re- 
pose 15 

sleep of W 

state of, during sleep 14 



INDEX 



237 



Page. 

Mind-reading 218, 227 

tii, summer climate of, favor- 
able to sleep 45 

Mitchell, S. Weir, observations of, 
^ tiding effect of variable bar- 

omc tr lc pressure 47 

Molecular moroment, Its relation to 

-'•neratlon of Ideas 24 

Moral responsibility lu soranambu- 

Uam 

Morphia 97. 98. 100, 101 

Morphine influence of, on oxidation 

in th 10 

i the circulation 

of blood during sleep M 

;>!rat!on during sleep 5 

Month, condition of, during sleep.. 8 

' ■! ■ ■ of sleep upon 12 

fibrillary twitching of, during 

bleep 3 



Monk 67, ioo, 105 

: 63 

i. state of secretion 

during sleep 8 

Narcotic Knpor 29 

I'iuii, affec- 
tions of 89, 49 

pnenmogattrlc 51 

sympathetic, affectlom of, causes 

of Insomnia 50 

Verroma dlaorden, Inonmnla of, re- 
lieved with paraldehyde 80 

hypnotic treatment of 229 

i- Irritation, effect of , on ti>- 

ehange 10 

58, 59 

stimulants 58, 59 

n, its control over the circu- 
latory apparatus 26 

Neuralgia, cardiac 99 

treatment of. with alcohol 71 

treatment of, with belladonna ... 69 
treatment of, with preparations of 

valerian 68 

Neura-ahenic patients 66 

New Providence, climate of, benefi- 
cial In Insomnia 114 

Night and day, alternation of, a cause 

Of sleep 17 

Night terrors 179 

treatment of. 89, 112 

Nitric acid 72 

Noctambulizm. 169 

ileep prevented by 41 

North China Herald, criticism of Sir 

i: Hornby's narrative 155 

Norway, difficulty of sleeping during 

the summer 40 

Nutrition, effect of sleep upon 5, 9 

disorders of - 52 

Obersteiner. his theory of sleep 20 

affect of, upon sleep 11 

Old age, decline of life In 113 

Omphaloacopy.. 217 

Opium and opiates 84, 98 



Page. 
Opiates, use of, in treatment of ca- 
chexias 108 

use of, In treatment of fever. . . 104, 105 
use of, In treatment of gastric dis- 
ease 103 

use of, in treatment of insanity... 96 
use of, in treatment of renal dis- - 

eases 102 

use of, in treatment of rheuma- 
tism 105 

Oxaluria, insomnia caused by 72 

Oxygen, absorption of , during sleep. 9 
Ozone, use of, in the treatment of 

asthma 101 

Pacific Islanders, habits of, regard- 
ing sleep in the daytime 40 

use of massage among 61 

Pain, a cause of sleep 19 

Paraldehyde 79, 95, 97, 108 

Paregoric 100 

Perception, effect of, upon nervous 

tissue 10 

duration of, necessary to arouse 

consciousness 23 

range of, circumscribed by sleep.. 12 
transfer of, In telepathy and hyp- 
notism 217 

Percussion 61 

Perspiration, secretion of, during 

sleep 9 

Pettenkofer, experiments of, on oxi- 
dation in the tissues 9 

experiments of, on respiration in 

sleep 6 

Pettenkofer and Voit, on tissue 

changes , 10 

Pfliiger, hypothesis of, regarding the 

cause of sleep 21 

Phosphatlc diathesis, a cause of in- 
somnia 72 

Phosphoric acid 72 

Phosphorus 71 

Phthisis, cough of, relieved with lac- 

tucarium 88 

insomnia of, relieved with paralde- 
hyde - 80 

treatment of, with opiates 87 

Physiological activity, reduction of, 

during sleep.-.— - 5 

Physiological cause of somnambu- 
lism 180 

Planchette-writing 228 

Pleuritic pain 99 

Pneumogastric nerves, insomnia 

caused by affections of 51 

Pneumonia 68, 100 

Porter, effects of 76 

Potassium bromide 88 

Preyer, his theory of sleep 20 

Psychical Research, Society for, in- 
vestigations by 149, 217 

Pulse, state of, during sleep 6 

Punkah, use of, to promote sleep 44 

Quetelet, observations of, on respi- 
ration during sleep 5 

Quinine and opium, use of, in fever. 104 



238 



INSOMNIA. 



Page. 
Reasoning powers, arrest of, during 

sleep 3 

Recollection of the events of artifi- 
cial somnambulism 227 

of the events of natural somnam- 
bulism 188 

Reflex movements during sleep. ... 12 

Refrigeration, threefold effect of 49 

Relation between molecular move- 
ment and the generation of ideas 24 

Respiration during sleep 5 

Revelation through dreams 160 

Revery, nature of 120 

Rheumatic diathesis, a cause of In- 
somnia 72 

Rosenthal, observations of, regard- 
ing lethargy 33, 34 

observations regarding apparent 

death 35 

Rush, Dr., observations of, on the re- 
vival of memory in dissolution. . 165 
Sailors, sleeping during a bombard- 
ment 1 

Sailor-boy, sleeping on a mast 1 

Salicylic acid, treatment of rheuma- 
tism with 106 

Saliva, secretion of, during sleep 8 

Samuel the prophet, dream of 129 

Sandwich Islands, climate of, for re- 
lief of insomnia 114 

Scarlet fever, treatment of, with 

baths 74, 75 

Scharling, observations of, regarding 
bodily temperature during sleep. 7 
experiments of, on oxidation in the 

tissues 9 

Screaming fits of children 112 

Secretion, state of, during sleep 8 

Sedatives, nervous 59, 73 

Self-hypnotism 219 

Sensory excitement, effect of, upon 

the cerebral circulation 27, 28 

Sensory organs, condition of, during 

somnambulism 191 

Sexual organs, irritability of 90 

Shampooing 61 

Simon, P. Max, case of somnambu- 
lism re at ed by 182 

dream related by 142 

Sleep, affected by certain winds 45 

artificial, mode of its production.. 22 
caused by the alternation of day 

aud night 17 

caused by depressing emotions 19 

caused by exhaustion 19 

caused by fatigue 19 

caused by painful impressions 19 

caused by the venereal act 19 

definition of. 1 

dreamless 14 

duration of 4, 110 

effects of its invasion upon the In- 
tellectual faculties 13 

effect of, upon consciousness.. -13, 14 

fatigue theory of 80 

favored by darkness 18 



Page. 
Sleep, favored by the suppression of 

sensation 18 

hindered by heat 44 

hindered by light 39 

hindered by smells 42 

hindered by sounds.. 41 

introductory stage of.. 2 

invasion of 10, 117 

measure of its depth by the experi- 
ments of Kohlschutter 16 

Obersteiner's theory of.. 20 

Pfliiger's hypothesis regarding the 

cause of 21 

preceeded by sleepiness 2 

Preyer 8 theory of 20 

rapid induction of, in certain cases 24 
relation between the duration of, 
and the average length of the 

night 17 

stages of 4 

the cause of 29 

unequal incidence of, upon differ- 
ent portions of the brain . 13 

Sleep-drunkenness 180, 181 

Sleepiness, precursive of sleep 2 

Sleeping dropsy 30 

Sleeplessness, causes of 39 

Smells, abolition of sleep by 42 

Smile, during sleep 12 

Smith. E., experiments of, on oxida- 
tion in the tissues 9 

Snoring, occasional interruption of 

sleep by n 

Society for Psychical Research, in- 
vestigations by 149, 217 

Sodium bromide H 

Somniation lfi9 

Somnambulic dreams 171, 17s 1^1 

recollections of 188 

Somnambulic form of artificial som- 
nambulism 222 

Somnambulic lethargy 171, 173 

contrasted with lucid lethargy 176 

Somnambulic life 169, 204 

a case of 206 

a case of, related by Azam 808 

a case of, related by Macnish 206 

Somnambulism 166 

artificial 214 

case of, related by Prof. J. Adams 

Allen 1S5 

case of. related by J. P. Frank 195 

case of, related oy Macario 192 

case of, related by Mesnet 196 

case of, related by P. Max Simon. 168 

causes of 166 

condition of sensory organs during. 191 
dependence of, upon partial sleep 

of the brain 11 

likeness of. to hypnotism 

moral responsibility in 203 

phenomena of 167, 210 

physiological cause of ISO 

relation of memory with events 

of 192 

varieties of, according to A. Maury, 16S 



INDEX. 



289 



Page. 
Somnambulism, varieties of. accord- 
ing to Ball and Chambard 169 

varieties of, dlagrammatlcally ex- 
hibited ..172 

violent impulses during 193 

Somnolence 80 

Somnolentia 180, 181 

Sound, effect of, to ti.nder sleep 42 

effed of, to induce sleep 42 

lie croup .. no 

Specie] -cum' organs, affections of .. 39 
Special senses, condition of, during 

Invasion of ileep 11 

perversion of, during the hypnotic 

■ 22:i 

Spinal cord, irritability of 110 

reflex energy of, during sleep 3 

Spinal Irritation 62 

Spirit of chloroform 81 

Spiritual circle, manlf (-stations in .. 227 

Stewart, Dugald, observation of 43 

Stimulant! after parturition 109 

in fever 105 

neryoua 59 

Stramonium 70, 101 

Btrflmpell, observations of, regard- 
ing sleep produced by suppression 

of sensation 18 

Strychnia 105 

Stupor produce. I I. y excessive heat or 

cold 47 

Subsultus tendlnum, treatment of, 

with musk 67 

Suction, involuntary, during infantile 

sleep __ 12 

Suppression of sensation, a cause of 

18 

Swedish movement cure 6: 

Sympathetic nerves, affectlonsof, 39, 50 
Table-rapping, method of communi- 
cation In 228 

Tannate of cannabin 68 

Tartar emetic, use of, in asthma 101 

use of, in delirium tremens 98 

. in fever 104 

use of, with opium 108 

Taste, relation of, to insomnia 43 

Tea, effect of, upon the brain 54 

Telegraphy without a wire, through 

water 147 

Telepathy, investigation of, by the 

Society for Psychical Research- 149 
Temperature, of the body, during 

sleep 7 

Of 43 

Thapsia 63 

Theory of sleep, Obersteiner's 20 



Page. 

Theory of Sleep, Pfliiger's 21 

Preyer^s 20 

Thirst.... g 

Thompson, Sir William, his doctrine 

concerning a sixth sense 43 

Tickling, effect of during sleep 12 

Tobacco, anti-spasmodic effect of, 71, 

99, 101 

Transfer of perceptions * 217 

Trousseau, observations of, on the 

pulse during sleep^... 6 

Tuberculosis of the cerebral mem- 
branes 55 

Tully'8 Powder 67 

Tumors of the brain 55 

Turkish baths 60 

Turpentine 63 

Typhoid fever, insomnia during 64 

treatment of, with baths 74 

treatment of, with musk 68 

treatment of, withTully's Powder, 67 
Typhus fever, treatment of, with 

musk 68 

Unconsciousness, produced by com- 
pression of the carotid arteries.. 27 
relation of, to modifications of the 

cerebral circulation 25 

Urea, elimination of, during sleep.. 9 

Urine, secretion of, during sleep 9 

Uterine colic 81 

Valerian 68, 109 

Valerianate of ammonia 68 

of zinc - 68 

Venereal act, a cause of sleep 19 

Vierordt, observations of, on the 

duration of sleep 110 

Visions, character of 119 

of the ancient prophets 161 

Volt, observations of, on oxidation in 

the tissues 9 

on respiration during sleep 6 

Volition, cessation of, during sleep.. 3 

Wakefulness 38 

causes of 39 

dependence of, upon instability of 

cerebral protoplasm 22 

Warburton, Rev. Canon, clairvoyant 

dream of 146 

Weariness, a cause of sleep 1 

Wharton and Stille, on sleep-drunk- 
enness 181 

Whooping-cough, treatment of, with 

belladonna 69 

Wind, effect of , upon sleep 45 

Wine, effects of 76 

use of, in the insomnia of old age. 78 

Ziemssen, von, on the use of baths.- 73 



